Correlates of Unstructured Antiretroviral Treatment Interruption in a Cohort of HIV-Positive Individuals in British Columbia

Treatment interruptions (TIs) limit the therapeutic success of combination antiretroviral therapy and are associated with higher morbidity and mortality. HIV-positive individuals dealing with concurrent health issues, access challenges and competing life demands are hypothesized to be more likely to interrupt treatment. Individuals were included if they initiated cART ≥1 year prior to interview date and had a CD4 cell count and initial regimen recorded at initiation. Using pharmacy recording, a TI was defined as a patient-initiated gap in treatment ≥90 consecutive days during the 12 months preceding or following the study interview. 117 (15.2 %) of 768 participants included in this study had a TI during the study window. 76.0 % of participants were male, 27.5 % were of Aboriginal ancestry and the median age was 46 (interquartile range 40–52). In multivariable logistic regression, TIs were significantly associated with current illicit drug use (adjusted odds ratio [aOR] 1.68, 95 % confidence interval [CI] 1.05–2.68); <95 % adherence in the first year of treatment (aOR 2.68, 95 % CI 1.67–4.12); living with at least one person (aOR 1.95; 95 % CI 1.22–3.14) or living on the street (aOR 5.08, 95 % CI 1.72–14.99) compared to living alone; poor perception of overall health (aOR 1.64 95 % CI 1.05–2.55); being unemployed (aOR: 2.22, 95 % CI 1.16–4.23); and younger age at interview (aOR 0.57, 95 % CI 0.44–0.75, per 10 year increase). Addressing socioeconomic barriers to treatment retention is vital for supporting the continuous engagement of patients in care.