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The CD4 cell count responses of 1522 antiretroviral-naive patients were evaluated initiating highly active antiretroviral therapy (HAART) that is satisfied by baseline CD4 cell count. This data demonstrated that substantial CD4 gains are possible among highly advanced adherent patients and should contribute to the ongoing debate over the optimal time to initiate HAART.

The objective of this study was to determine the prevalence of, and factors associated with, sexual violence in childhood, adolescence and adulthood, among injection drug using men and women. The Vancouver Injection Drug User Study is a prospective cohort of injection drug users (IDU) begun in 1996. The analysis included all individuals who completed the baseline questionnaire who responded to a question about sexual assault. Multivariate modeling was used to determine and to what extent a history of sexual violence at different ages is predictive of HIV risk and other health risk behaviors. HIV prevalence was calculated as the total current number of HIV-positive individuals in the cohort. Of the 1437 eligible individuals, 36% reported a lifetime history of sexual violence; 68% of women, and 19% of men (p < 0.001). After adjusting for fixed sociodemographics, these individuals were more likely to have ever been in the sex trade, to knowingly share needles/rigs with HIV-positive people, to have attempted suicide, to have ever accidentally overdosed, to binge on alcohol, and to have been diagnosed with a mental disorder/disability. The prevalence of child sexual abuse in this cohort is 21%; 33% for women, and 13% for men. The data show a dose-response relationship between age at first sexual violence and most risk behaviors examined. These relationships are further mediated by gender. The prevalence of HIV among individuals who ever experienced sexual violence was 25%, compared to 19% among those who never experienced sexual violence (p = 0.006). Sexual violence, and especially child sexual abuse, is highly prevalent among this cohort, particularly among women. Child sexual abuse has worse consequences for both genders than sexual violence later in life. Nevertheless, women and men are affected differently by sexual violence at different ages, and this has significant implications for health promotion programs, and specifically HIV prevention. Keywords: Sexual violence; Child sexual abuse; Suicide; Mental illness; HIV; Canada

Research has been conducted on medically supervised injection facilities. Results demonstrate that due to ongoing health crisis among injection drug users in different Canadian cities these people are willing to attent medically supervised safer injection facilities.

Research has been conducted on the patient-mediated intentional alterations in antiretroviral medication regiments. Results indicate that these alterations are common among the patients with therapy-related side effects.

Research has been conducted on the blood-borne infection reduction among injection drug users. Results indicate that clean needles and syringes distributed among injection drug users in Canada have reduced high-risk behaviors and blood-borne infection transmission and stress the importance of satellite needle distribution among injection drug users.

Population-based estimates of the incidence of constituent symptoms associated with HIV-related lipodystrophy syndrome are presented. Incident cholesterol of triglyceride abnormalities were associated with protease inhibitor use and duration of ritonavir. Findings suggest high annual rates of incidence and a role of first line antiretroviral therapies in symptom development. Important implications for evolving treatment patterns can be seen, with consideration of other findings.

Research has been conducted on the HIV prevalence and HIV infection risk factors among young injection drug users. Results demonstrate that HIV positivity among young injection drug users concentrates among females engaged in sexual and drug-related risk exposure activities.

An increase in CD4 T cell counts in HIV patients almost always occurs when blood levels of the virus decrease, according to a study of 574 HIV patients who were taking AIDS drugs. This decrease in viral load may be temporary, however, which might account for some reports that CD4 T cell counts can increase even if viral load remains the same.

Researchers describe a PCR test that can measure the amount of mitochondrial DNA in blood samples. This can be used to identify HIV patients who have mitochondrial damage caused by some AIDS drugs. The test showed that HIV patients taking AIDS drugs had much lower amounts of mitochondrial DNA than patients not taking AIDS drugs or a group of healthy volunteers.

HIV infection often contributes to the death of intravenous drug addicts, according to a study of 1,400 drug addicts. About one-third of the deaths among the HIV-positive addicts were linked to HIV infection.

HIV patients whose CD4 T cell counts are less than 200 are more likely to die than those with higher counts even if they are taking highly active antiretroviral therapy (HAART). This was the conclusion of a study of 1,219 HIV patients., Context Current recommendations for initiation of antiretroviral therapy in patients infected with human immunodeficiency virus type 1 (HIV) are based on CD4 T-lymphocyte cell counts and plasma HIV RNA levels. The relative prognostic value of each marker following initiation of therapy has not been fully characterized. Objective To describe rates of disease progression to death and AIDS or death among patients starting triple-drug antiretroviral therapy, stratified by baseline CD4 cell count and HIV RNA levels. Design, Setting, and Participants Population-based analysis of 1219 antiretroviral therapy-naive HIV-positive men and women aged 18 years or older in British Columbia who initiated triple-drug therapy between August 1, 1996, and September 30,1999. Main Outcome Measure Cumulative mortality rates from the initiation of triple-drug antiretroviral therapy to September 30, 2000, determined using various CD4 cell and plasma HIV RNA thresholds. Results As of September 30, 2000, 82 patients had died of AIDS-related causes, for a crude AIDS-related mortality rate of 6.7%. The product limit estimate (SE) of the cumulative mortality rate at 12 months was 2.9% (0.5%). In univariate analyses, a prior diagnosis of acquired immunodeficiency syndrome (AIDS), CD4 cell count, use of protease inhibitors, and HIV RNA level were associated with mortality. There was no difference in mortality by age or sex. Only CD4 cell count remained statistically significant in the multivariate analysis. After controlling for AIDS, protease inhibitor use, and plasma HIV RNA level at baseline, patients with CD4 cell counts of less than 50/[micro]L were 6.67(95% confidence interval [Cl], 3.61-12.34) times and those with counts of 50/[micro]L to 199/[micro]L were 3.41 (95% Cl, 1.93-6.03) times more likely to die than those with counts of at least 200/[micro]L. Conclusion Our data demonstrate uniformly low rates of disease progression to death and AIDS or death among patients starting antiretroviral therapy with CD4 cell counts of at least 200/[micro]L. In our study, disease progression to death and AIDS or death was clustered among patients starting therapy with CD4 cell counts less than 200/[micro]L.

The objective of this study is to describe the relationship between socio-demographic characteristics and the geographic distribution of persons with HIV in the metropolitan area surrounding Vancouver, British Columbia. Specifically, we sought to determine the location of persons with HIV and the population based characteristics related to the rate of anti-HIV medication use. In addition, we investigated the relationship between the distribution of persons on anti-HIV medications and the city's monorail 'SkyTrain' route. The residences of persons on anti-HIV therapy were linked to Census Tracts. Data from the most recent census were used to create a sociodemographic profile of each geographic area. The spatial relationship between the distribution of persons on anti-HIV therapy and the path of the monorail was assessed by digitizing the SkyTrain route over a digital Census Tract map. Statistical analyses were used to determine the characteristics of Census Tracts associated with the rate of anti-HIV medication use. The overall rate of anti-HIV medication use in the Census Tracts that are within 1 km of SkyTrain was 66 per 100,000 population, whereas the rate was only 22 in the non-proximal Census Tracts. Multivariate analyses indicated that persons on anti-HIV therapy were significantly less likely to reside where there is a higher proportion of the population female, and were more likely to reside in areas with a higher proportion of the population of First Nations or Aboriginal descent, a higher population density, and in areas within 1 km of the SkyTrain route. Our analyses suggest that neither migration, nor a heightened access to therapy explain these findings. The environment surrounding the SkyTrain may have been conducive to the spatial diffusion of HIV, and could be the focus of targeted public health interventions. The mechanisms responsible for the clustering of persons on anti-HIV medications around the SkyTrain require further investigation.

Protease inhibitors may improve some HIV patients' mental health. This was the conclusion of a study of 453 HIV patients taking a protease inhibitor, of whom 234 were depressed at the start of treatment.

Combination drug therapy for HIV infection appears to lower mortality rates and prolong survival. Researchers followed 1,178 patients who began therapy with more than one antiviral drug between 1992 and 1996. By 1996, five drugs had been approved to treat HIV infection: zidovudine, didanosine, zalcitabine, lamivudine or stavudine. One-third of the patients died during the study. Those who were treated with combination therapy including zidovudine, didanosine or zalcitabine were about twice as likely to die and more likely to progress to AIDS as those whose treatment included lamivudine or stavudine.