Background: Women living with HIV are less likely to achieve optimal antiretroviral adherence and retain HIV-1 RNA viral load non-detectability compared to men. Risk factors for viral rebound may differ by sex. This study''s objective was to evaluate the impact of sociodemographic, behavioral, and clinical factors on the hazard of viral rebound after achieving viral suppression for a cohort of women living with HIV who use illicit drugs.
Methods: We used longitudinal data from 2005-2017 for women living with HIV who use illicit drugs enrolled in the ACCESS study, a prospective cohort with systematic HIV viral load monitoring. Women were included if they achieved viral suppression (i.e., HIV-1 RNA viral load < 50 copies/mL) following antiretroviral therapy initiation and had more than one study interview. Sociodemographic as well as substance use, addiction treatment, and HIV clinical factors were evaluated as predictors of viral rebound (i.e., HIV viral load >1000 copies/mL). Cox regression using a recurrent events framework, time-varying covariates, and robust standard errors were used.
Results: Of the 206 women included, nearly half (46%) are Indigenous, 4.4% are transgender women, and a quarter self-identified as a sexual minority. Over the 12-year period, 40% (n=83) experienced at least one virologic failure, accumulating a total of 115 viral rebound events. In adjusted analysis, the only factor associated with viral rebound was receipt of medication assisted treatment (MAT) in the past six months. Figure1 compares probability of viral rebound by MAT status. Women who received MAT had half (adjusted hazard ratio: 0.49, 95% confidence limits: 0.28-0.88) the hazard of viral rebound compared to women who had not received MAT.
Conclusions: This study provides additional evidence that MAT can improve HIV treatment outcomes among women. Efforts to improve access to and retention within MAT programs may improve rates of viral suppression for HIV-infected women who use illicit drugs.

Kaplan-Meier curve of time to first viral rebound following suppression by MAT status
[Kaplan-Meier curve of time to first viral rebound following suppression by MAT status ]