People with HIV and Injection Drug Use Who Initiate Antiretroviral Therapy Do Not Increase Needle Sharing

Antiretroviral therapy (ART) reduces the transmission of HIV by lowering the viral load in infected individuals. However, there is some concern this knowledge leads to more HIV-related risk behaviors, including sharing needles. Researchers in Vancouver, Canada, prospectively collected 2100 person-years of observational data in a cohort of 380 men and women with HIV and injection drug use, 260 of whom initiated ART between 1996 and 2008. A generalized linear mixed-effects multivariable model was used to examine the independent association between ART initiation and lending of used syringes.

• In the bivariable analysis, ART initiation was not significantly associated with syringe sharing.

• Syringe sharing was significantly higher among people who were homeless (odds ratio [OR], 1.48) or who had frequent heroin injection (OR, 2.84), frequent cocaine injection (OR, 3.17), higher CD4 count (OR, 1.16). or higher viral load (OR, 1.58). It was significantly lower among those on methadone maintenance (OR, 0.60).

• In the multivariable analysis, ART initiation was again not significantly associated with syringe sharing. Factors that remained significantly associated with syringe sharing were frequent cocaine use (OR, 2.62) and higher viral load (OR, 1.45).

Comments:

This study suggests initiation of ART does not lead to increased needle sharing, at least in a locale where there is access to needle exchange programs and free health care. Interventions that reduce cocaine use may help reduce HIV-related risk behaviors.

Darius A. Rastegar, MD

Reference:

Kuyper L, Milloy MJ, Marshall BD, et al. Does initiation of HIV antiretroviral therapy influence patterns of syringe lending among injection drug users? Addict Behav. 2011;36(5):560–563.