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Virological suppression among gay, bisexual, and other men who have sex with men living with HIV in Vancouver, Canada: a longitudinal cohort study from 2012–2017

Virological suppression among gay, bisexual, and other men who have sex with men living with HIV in Vancouver, Canada: a longitudinal cohort study from 2012–2017
Virological suppression among gay, bisexual, and other men who have sex with men living with HIV in Vancouver, Canada: a longitudinal cohort study from 2012–2017
Introduction: in 2010, British Columbia (BC) implemented HIV Treatment as Prevention (TasP) as policy. We examined trends in virologic suppression and determinants of significant viremia among a prospective biobehavioural cohort of men who have sex with men (gbMSM) in Vancouver from 2012–2017.Methods: respondent-driven sampling was used to recruit sexually active gbMSM (≥16 years) who completed biannual study visits with a computer-assisted self-interview and clinical CD4 and viral load (VL) testing. We linked participant data with the BC HIV Drug Treatment Program to obtain antiretroviral dispensing and VL data. We conducted a trend analysis of VL suppression using univariable generalized estimating equation (GEE) multi-level modelling and multivariable GEE to identify factors associated with episodes of VL ≥200 copies/mL.Results: of 774 participants, 223 were living with HIV at baseline and 16 were diagnosed during follow-up (n = 239). We observed a significant trend towards reduced levels of unsuppressed VL (>200 copies/mL) from 22% (07/2012-12/2012) to 12% (07/2016-12/2016) (OR:0.87; 95%CI:0.83–0.91 for each 6-month period). Among those with at least one follow-up visit, (n = 178, median follow-up = 3.2 years, median age = 46.9 years), younger age (aOR:0.97; 95%CI:0.94–0.99, per year), ecstasy use (aOR:1.69; 95%CI:1.13–2.53), crystal methamphetamine use (aOR:1.71; 95%CI:1.18–2.48), seeking sex via websites (aOR:1.46; 95%CI:1.01–2.12), and lower HIV treatment optimism (aOR:0.94; 95%CI:0.90–0.97) were associated with episodes of elevated viremia.Conclusions: during a period when TasP policy was actively promoted, we observed a significant trend towards reduced levels of unsuppressed VL. Continued efforts should promote HIV treatment optimism and engagement, especially among younger gbMSM and those who use ecstasy and crystal methamphetamine.
1932-6203
e0276596
Armstrong, Heather
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Gitleman, Julian
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Cui, Zishan
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Bacani, Nicanor
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Sereda, Paul
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Lachowsky, Nathan J.
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Card, Kiffer G.
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Sang, Jordan
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Raymond, Henry F.
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Montaner, Julio S.G.
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Hall, David
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Howard, Terry
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Hull, Mark
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Hogg, Robert S.
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Roth, Eric A.
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Moore, David M.
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Armstrong, Heather
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Gitleman, Julian
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Cui, Zishan
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Bacani, Nicanor
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Sereda, Paul
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Lachowsky, Nathan J.
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Card, Kiffer G.
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Sang, Jordan
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Raymond, Henry F.
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Montaner, Julio S.G.
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Hall, David
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Howard, Terry
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Hull, Mark
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Hogg, Robert S.
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Roth, Eric A.
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Moore, David M.
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Armstrong, Heather, Gitleman, Julian, Cui, Zishan, Bacani, Nicanor, Sereda, Paul, Lachowsky, Nathan J., Card, Kiffer G., Sang, Jordan, Raymond, Henry F., Montaner, Julio S.G., Hall, David, Howard, Terry, Hull, Mark, Hogg, Robert S., Roth, Eric A. and Moore, David M. (2022) Virological suppression among gay, bisexual, and other men who have sex with men living with HIV in Vancouver, Canada: a longitudinal cohort study from 2012–2017. PLoS ONE, 17 (10), e0276596, [e0276596]. (doi:10.1371/journal.pone.0276596).

Record type: Article

Abstract

Introduction: in 2010, British Columbia (BC) implemented HIV Treatment as Prevention (TasP) as policy. We examined trends in virologic suppression and determinants of significant viremia among a prospective biobehavioural cohort of men who have sex with men (gbMSM) in Vancouver from 2012–2017.Methods: respondent-driven sampling was used to recruit sexually active gbMSM (≥16 years) who completed biannual study visits with a computer-assisted self-interview and clinical CD4 and viral load (VL) testing. We linked participant data with the BC HIV Drug Treatment Program to obtain antiretroviral dispensing and VL data. We conducted a trend analysis of VL suppression using univariable generalized estimating equation (GEE) multi-level modelling and multivariable GEE to identify factors associated with episodes of VL ≥200 copies/mL.Results: of 774 participants, 223 were living with HIV at baseline and 16 were diagnosed during follow-up (n = 239). We observed a significant trend towards reduced levels of unsuppressed VL (>200 copies/mL) from 22% (07/2012-12/2012) to 12% (07/2016-12/2016) (OR:0.87; 95%CI:0.83–0.91 for each 6-month period). Among those with at least one follow-up visit, (n = 178, median follow-up = 3.2 years, median age = 46.9 years), younger age (aOR:0.97; 95%CI:0.94–0.99, per year), ecstasy use (aOR:1.69; 95%CI:1.13–2.53), crystal methamphetamine use (aOR:1.71; 95%CI:1.18–2.48), seeking sex via websites (aOR:1.46; 95%CI:1.01–2.12), and lower HIV treatment optimism (aOR:0.94; 95%CI:0.90–0.97) were associated with episodes of elevated viremia.Conclusions: during a period when TasP policy was actively promoted, we observed a significant trend towards reduced levels of unsuppressed VL. Continued efforts should promote HIV treatment optimism and engagement, especially among younger gbMSM and those who use ecstasy and crystal methamphetamine.

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Accepted/In Press date: 11 October 2022
Published date: 21 October 2022

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Local EPrints ID: 471827
URI: http://eprints.soton.ac.uk/id/eprint/471827
ISSN: 1932-6203
PURE UUID: 3707d459-ffa3-4033-880f-a04d119a0c0f
ORCID for Heather Armstrong: ORCID iD orcid.org/0000-0002-1071-8644

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Date deposited: 21 Nov 2022 17:49
Last modified: 24 Nov 2022 02:58

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Contributors

Author: Julian Gitleman
Author: Zishan Cui
Author: Nicanor Bacani
Author: Paul Sereda
Author: Nathan J. Lachowsky
Author: Kiffer G. Card
Author: Jordan Sang
Author: Henry F. Raymond
Author: Julio S.G. Montaner
Author: David Hall
Author: Terry Howard
Author: Mark Hull
Author: Robert S. Hogg
Author: Eric A. Roth
Author: David M. Moore

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