OBJECTIVE:We assessed sex differences in hospitalization rates among people with HIV (PWH) and people without HIV (PWoH) in British Columbia (BC). METHODS:PWH and a 10% random sample of PWoH in BC aged ≥19 were followed from 04/01/2002 to 03/31/2020, using linked administrative Comparative Outcomes and Service Utilization Trends (COAST) study data. Hospitalizations were categorized by discharge diagnosis, using broad International Classification of Diseases-classes. Using Poisson regression, we modelled the association between sex, HIV-status, their interaction, and hospitalization rates adjusting for confounders. RESULTS:Among 12,635 PWH (17.81% females) and 548,992 PWoH (49.34% females), age-adjusted hospitalization rates per 100 person-years were highest among females with HIV [incidence rate (IR) 34.25], followed by males with HIV (IR 21.49), females (IR 7.10), and males (IR 7.06) without HIV. Hospitalization rates for all causes declined from 2002-2022 across all subgroups but remained consistently higher among females with HIV, except for circulatory diseases and neoplasms. Adjusted for socio-structural factors, being male [rate ratio (RR) 1.92] or female with HIV (RR 2.66) was significantly associated with a higher hospitalization rate compared to males without HIV. Among PWH, female sex remained significantly associated with a higher hospitalization rate, after adjusting for HIV- and disease-related factors. CONCLUSIONS:We found a higher hospitalization rate among PWH than PWoH in BC, with the highest rate among females with HIV. This could partially be explained by socio-structural factors. Addressing these disparities and improving our understanding of the underlying mechanisms is critical to enhance health outcomes for women with HIV.

Maintaining a suppressed HIV plasma viral load (pVL) is critical to the optimal management of people living with HIV (PLWH), and to prevent HIV transmission. We examined trends and determinants of unsuppressed pVL among PLWH from April 2005 to March 2020 in British Columbia (BC), Canada by HIV exposure groups. We analyzed data from all PLWH in BC identified in a provincial database linking testing, treatment, laboratory, pharmacy and administrative health data. For each year, individuals were classified as having an unsuppressed pVL if they were newly diagnosed, had any pVL ≥ 200 copies/mL test result, or had no pVL measurement. We used univariate generalized estimating equations (GEE) to examine trends over time and multivariate GEE modelling to examine factors associated with unsuppressed pVL. PLWH in BC increased from 5712 in 2005 to 8012 in 2020, and the proportion of those with pVL ≥ 200 copies/mL decreased from 66.4

People living with HIV (PLWH) in Canada experience high rates of interpersonal violence which may lead to adverse health outcomes that require hospitalization. Using self-reported data on experiences of violence linked to administrative health data on hospitalizations, we used Poisson regression modelling to examine and compare the associations between experiences of violence (recent [in the past 6 months], non-recent [>6 months ago], or none) and hospitalization rates, among a sample of PLWH in British Columbia, Canada. Of 984 PLWH included in this study, 60.0% reported experiencing non-recent violence, and 14.8% experienced recent violence. Those who experienced non-recent violence had a higher rate of hospitalization than those who never experienced violence (adjusted Rate Ratio [aRR]: 1.41; 95% Confidence Interval [CI]: 1.05-1.87). There was no difference in hospitalization rates between those who experienced recent violence and those who never did (aRR: 1.08; 95% CI: 0.74-1.60). PLWH who experienced recent violence had the highest proportion of hospitalizations attributed to mental, behavioural, or neurodevelopmental disorders. Efforts are needed to provide violence-aware care that recognizes violence and its impacts on PLWH experiencing multiple sociostructural inequities. Further studies should evaluate the impacts of violence on other types of healthcare utilization in generalizable samples of PLWH in Canada.

Objectives Our study investigated the age-adjusted incidence rates of non-fatal overdoses by HIV status and sex, and examined trends over time.Design We used data from the Comparative Outcomes and Service Utilization Trends study, a population-based cohort study that includes clinical and administrative health data on virtually all people with HIV (PWH) and a 10% random sample of people without HIV in the province.Setting British Columbia, Canada.Participants Between April 2012 and March 2020, 11 050 PWH (81.8% male) and 473 952 people without HIV (50.3% male) who were 19 years and older contributed 68 035 and 3 285 824 person years (PY) of follow-up, respectively.Outcome measures The primary outcome was age-adjusted incidence rates of non-fatal overdose events stratified by sex and HIV status. Trends over time were also assessed.Results Age-adjusted non-fatal overdose incidence rates among males with and without HIV were 36.4 and 3.12 per 1000 PY, respectively (incidence rate ratio (IRR) = 11.7, 95% CI 10.9 to 12.5). For females with and without HIV, the age-adjusted incidence rates were 61.4 and 2.33 per 1000 PY, respectively (IRR=26.3, 95% CI 24.0 to 28.7). Between 2013 and 2019 (calendar years with full-year data), the age-adjusted non-fatal overdose rate increased significantly among males and females without HIV but not among PWH.Conclusions We observed a significantly higher non-fatal overdose rate among PWH compared to people without HIV. The rate was highest among females with HIV. These findings underline the need for policies and programmes oriented towards PWH to mitigate overdoses, especially for females.

People living with HIV (PLWH) face disproportionate rates of suicide death despite improvements in quality of life with antiretroviral therapy. Effective preventative efforts necessitate an understanding of healthcare utilization trends prior to suicide death for PLWH to facilitate the identification of areas for improvement in screening and prevention. The present study aimed to identify patterns of healthcare utilization in PLWH who died by suicide using a population-based cohort design. Administrative datasets from British Columbia, Canada were analyzed using unadjusted and adjusted logistic regression models to assess healthcare utilization in the 90-day period prior to suicide death for 98 PLWH and 170 age- and sex-matched people without HIV (PWoH). PLWH were found to have greater rates of healthcare engagement prior to suicide death, with increased likelihood of any healthcare visit and a greater median count of total healthcare visits compared to controls. Despite this, no significant difference in degree of engagement with mental healthcare and self-harm healthcare services was observed between PLWH and PWoH. These findings suggest that PLWH who die by suicide engage with the healthcare system more than their counterparts without HIV, and point to the importance of differential screening and prevention strategies for PLWH on antiretroviral therapy.

AIM:For several decades, British Columbia (BC), Canada, has been experiencing a housing crisis marked by a shortage of safe and affordable housing, which coincides with a severe drug poisoning epidemic in the region. We explore the impact of housing instability on mortality (all-cause, drug-related) among a cohort of people with HIV (PWH) in BC. METHODS:Data are from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) study (n = 997). Data from the cross-sectional LISA survey (2007-2010) are linked with administrative health data from Population Data BC and the BC Centre for Excellence in HIV/AIDS Drug Treatment Program (DTP) until March 31, 2020. We used inverse probability of participation weighting (IPPW) to address selection bias, introduced in LISA through oversampling of PWH marginalized by sociostructural inequities. We constructed participation weights using information from the DTP database, which includes all known PWH in BC accessing antiretrovirals via the DTP (including respondents and non-respondents to LISA). We estimated hazards of all-cause and drug-related mortality associated with housing instability using an adjusted, IPPW-weighted Cox proportional hazards model. RESULTS:In this sample, 317 (31.8%) people reported housing instability. Overall, 302 people (30.3%) died from any cause between the completion of the LISA survey until March 31, 2020; of those people, 138 (45.7%) experienced housing instability. Results suggest housing instability is associated with increased hazards of all-cause mortality (adjusted Hazards Ratio (aHR): 1.46; 95% CI: 1.08-1.96). The association between housing instability and hazards for drug-related mortality include a range of values consistent with the null (aHR: 1.67; 95% CI: 0.89-3.13). CONCLUSION:PWH experiencing housing instability may have greater hazards of all-cause mortality. Our findings add to the literature supporting a need to expand access to safe and affordable housing.

We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people.

Accidental overdoses are now the leading cause of death among people with HIV (PWH) in British Columbia (BC). We examined the utilization and retention of opioid agonist therapy (OAT). Adult PWH (& GE;19 years) with & GE; 1 OAT dispensation in BC between 2008 and 2020 were included (n = 1,515). OAT treatment episodes were formed based on specific criteria for slow-release oral morphine (SROM), meth-adone, injectable OAT (iOAT), and buprenorphine/naloxone. Retention in treatment was defined as any episode lasting & GE; 12 months. Logistic regression with generalized estimating equations modeled retention-associated factors. There was a 56.6% decline in OAT retention over time. Buprenorphine treatment exhibited significantly lower odds of retention (OR: 0.58; 95% CI: 0.36-0.92) compared to methadone. Conversely, no significant change in retention odds was observed for SROM (0.72; 0.33-1.54) and iOAT (0.81; 0.31-2.12). Factors associated with increased odds of retention included a 10-year increase in age (1.69; 1.46-1.95), previous retention history (1.96; 1.40-2.73), achieving OAT therapeutic dose (8.22; 6.67-10.14), and suppressed HIV viral load (1.35; 1.10-1.67). Individuals with a lifetime HCV diagnosis receiving iOAT were more likely to retain (3.61; 1.20-10.83). Each additional year on OAT during the study period was associated with a 4% increase in the odds of retention. A significant proportion of PWH had a history of OAT prescribing but experienced low retention rates. Retention outcomes were more positive for SROM and iOAT. The association between OAT medication type and retention odds may be particularly influenced by HCV diagnosis. Optimal management of opioid use disorder among PWH, with an emphasis on attaining the therapeutic dose is crucial.

OBJECTIVE:There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population. METHODS:Population-based health data were accessed for 2 cohorts of HIV-positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV-positive cohort was compared to the expected age-, sex-, calendar year-, income-specific, and region of birth-specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART-exposed") was also calculated. RESULTS:The combined Sweden-Canada cohort included 29,163 (75% men) HIV-positive persons. During 242,248 person-years of follow-up, 14 incident MS cases were observed in the HIV-positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV-positive population was 0.53 (95% confidence interval [CI] = 0.32-0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31-0.96). INTERPRETATION:This international population-based study demonstrated a lower risk of MS among HIV-positive individuals, and HIV-positive ART-exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2024;95:487-494.

Background: Socioeconomic status has been associated with higher viral loads and lower CD4 cell counts among people living with HIV. The objective of this study was to evaluate the relation between neighbourhood-level material deprivation and immunologic and virologic response to combination antiretroviral therapy (ART) among people living with HIV in Canada. Methods: The Canadian Observational Cohort (CANOC) is a longitudinal cohort of people living with HIV, containing data from 2000–2016 from 5 Canadian provinces. We defined response to combination ART as positive if the CD4 cell count increased by 50 cells/mm3 (0.05 cells × 109/L) or more (CD4+) and viral load decreased to 50 copies/mL or less (VL+) within 6 months of treatment initiation. We further categorized response to therapy as concordant positive (CD4+/VL+), concordant negative (CD4−/VL−) or discordant (CD4+/VL− or CD4−/VL+). We used adjusted multinomial logistic regression to quantify the relation between neighbourhood-level material deprivation and immunologic and virologic response. Results: This study included 8274 people living with HIV, of which 1754 (21.2%) lived in the most materially deprived neighbourhoods. Most individuals (62.2%) showed a concordant positive response to combination ART. After adjustment, living in the most materially deprived neighbourhoods was associated with a CD4−/VL+ discordant response (adjusted odds ratio [OR] 1.31, 95% confidence interval [CI] 1.06–1.62) and a concordant negative response (adjusted OR 1.45, 95% CI 1.13–1.86), using a concordant positive response as the reference. No other deprivation quartile was independently associated with a particular response. Interpretation: People living with HIV from the most materially deprived neighbourhoods had increased odds of poor immunologic or virologic response to combination ART. These results motivate further study of the specific socioeconomic factors that potentially affect response to combination ART among people living with HIV in Canada.

ABSTRACT We assessed the relationship between tobacco smoking and immunologic and virologic response among people living with HIV (PLWH) initiating combination antiretroviral therapy (cART) in the Canadian HIV Observational Cohort (CANOC). Positive immunologic and virologic response, respectively, were defined as ≥50 cells/mm3 CD4 count increase (CD4+) and viral suppression ≤50 copies/mL (VL+) within 6 months of cART initiation. Using multinomial regression, we examined the relationship between smoking, immunologic, and virologic response category. Model A adjusted for birth sex, baseline age, enrolling province, and era of cohort entry; models B and C further adjusted for neighbourhood level material deprivation and history of injection drug use (IDU), respectively. Among 4267 individuals (32.7%) with smoking status data, concordant positive (CD4+/VL+) response was achieved by 64.2% never, 66.9% former, and 59.4% current smokers. In the unadjusted analysis, current smoking was significantly associated with concordant negative response (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.40–2.45). Similarly, models A and B showed an increased odds of concordant negative response in current smokers (adjusted OR [aOR] 1.78, 95% CI 1.32–2.39 and 1.74, 95% CI 1.29–2.34, respectively). The association between current smoking and concordant negative response was no longer significant in model C (aOR 1.18, 95%CI 0.85–1.65).

Objectives Innovative methods are needed for identification of transgender people in administrative records for health research purposes. This study investigated the feasibility of using transgender-specific healthcare utilisation in a Canadian population-based health records database to develop a computable phenotype (CP) and identify the proportion of transgender people within the HIV-positive population as a public health priority.Design The Comparative Outcomes and Service Utilization Trends (COAST) Study cohort comprises a data linkage between two provincial data sources: The British Columbia (BC) Centre for Excellence in HIV/AIDS Drug Treatment Program, which coordinates HIV treatment dispensation across BC and Population Data BC, a provincial data repository holding individual, longitudinal data for all BC residents (1996–2013).Setting British Columbia, Canada.Participants COAST participants include 13 907 BC residents living with HIV (≥19 years of age) and a 10% random sample comparison group of the HIV-negative general population (514 952 individuals).Primary and secondary outcome measures Healthcare records were used to identify transgender people via a CP algorithm (diagnosis codes+androgen blocker/hormone prescriptions), to examine related diagnoses and prescription concordance and to validate the CP using an independent provider-reported transgender status measure. Demographics and chronic illness burden were also characterised for the transgender sample.Results The best-performing CP identified 137 HIV-negative and 51 HIV-positive transgender people (total 188). In validity analyses, the best-performing CP had low sensitivity (27.5%, 95% CI: 17.8% to 39.8%), high specificity (99.8%, 95% CI: 99.6% to 99.8%), low agreement using Kappa statistics (0.3, 95% CI: 0.2 to 0.5) and moderate positive predictive value (43.2%, 95% CI: 28.7% to 58.9%). There was high concordance between exogenous sex hormone use and transgender-specific diagnoses.Conclusions The development of a validated CP opens up new opportunities for identifying transgender people for inclusion in population-based health research using administrative health data, and offers the potential for much-needed and heretofore unavailable evidence on health status, including HIV status, and the healthcare use and needs of transgender people.

ABSTRACT Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n = 503) and rehabilitation (7.73%, n = 433). Those who received HCC were more likely to be female (aOR = 1.56, 95% CI = 1.24, 1.98), have a history of injection drug use (aOR = 1.88, 95% CI = 1.57, 2.25), have a higher Charlson comorbidity score (aOR = 1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR = 2.17, 95% CI = 1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.

Introduction People living with HIV (PLHIV) are increasingly at risk of age-related comorbidities such as diabetes mellitus (DM). While DM is associated with elevated mortality and morbidity, understanding of DM among PLHIV is limited. We assessed the incidence of DM among people living with and without HIV in British Columbia (BC), Canada, during 2001–2013.Methods We used longitudinal data from a population-based cohort study linking clinical data and administrative health data. We included PLHIV who were antiretroviral therapy (ART) naïve at baseline, and 1:5 age-sex-matched persons without HIV. All participants had ≥5 years of historic data pre-baseline and ≥1 year(s) of follow-up. DM was identified using the BC Ministry of Health’s definitions applied to hospitalisation, physician billing and drug dispensation datasets. Incident DM was identified using a 5-year run-in period. In addition to unadjusted incidence rates (IRs), we estimated adjusted incidence rate ratios (IRR) using Poisson regression and assessed annual trends in DM IRs per 1000 person years (PYs) between 2001 and 2013.Results A total of 129 PLHIV and 636 individuals without HIV developed DM over 17 529 PYs and 88,672 PYs, respectively. The unadjusted IRs of DM per 1000 PYs were 7.4 (95% CI 6.2 to 8.8) among PLHIV and 7.2 (95% CI 6.6 to 7.8) for individuals without HIV. After adjustment for confounding, HIV serostatus was not associated with DM incidence (adjusted IRR: 1.03, 95% CI 0.83 to 1.27). DM incidence did not increase over time among PLHIV (Kendall trend test: p=0.9369), but it increased among persons without HIV between 2001 and 2013 (p=0.0136).Conclusions After adjustment, HIV serostatus was not associated with incidence of DM, between 2001 and 2013. Future studies should investigate the impact of ART on mitigating the potential risk of DM among PLHIV.

Objectives: High-dose opioid use is associated with increased morbidity, mortality, and healthcare utilization. People living with HIV (PLHIV) are frequently prescribed these medications to manage their pain. However, little is known about the relationship between being prescribed high doses of opioids ( > 90 MME/d) and mortality risk among this population. The objective of this study was to examine the trends in mortality and the relationship between high-dose opioid analgesic prescribing and mortality among PLHIV. Methods: Utilizing the STOP HIV/AIDS cohort-a population-level linked database of treatment of PLHIV in British Columbia-we conducted bivariable and multivariable generalized estimating equation (GEE) models with a Poisson distribution to examine the relationship between high-dose opioid prescription and all-cause mortality rates in the study sample. Results: Between 1996 and 2015, 9272 PLHIV were included in the study. Age- and sex-adjusted mortality rate (using the 2011 Canadian population as the reference) was 30.99 per 1000 person-years (95% confidence interval [CI]: 28.11-33.88). In a multivariable GEE model with adjustment for various demographic and clinical confounders, there was a positive and independent association between being prescribed high-dose opioids and all-cause mortality rates (adjusted rate ratio [ARR] = 3.01; 95%CI: 2.47-3.66). Discussion: We found that mortality rates were significantly higher among PLHIV who were prescribed high-dose opioids compared to those who were prescribed lower doses. Our results highlight the risk associated with the prescribing of high-dose opioids to manage HIV-related pain and emphasize the need to explore non-opioid approaches to pain management.

BACKGROUNDImproving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used.METHODSWe performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression: rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems.RESULTSVirologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas.INTERPRETATIONHealth outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.

Background: Co-prescribing benzodiazepine and opioid is relatively contraindicated due to the possible overdose risk. However, people living with HIV (PLWH) may have concurrent psychiatric and/or chronic pain diagnoses that may lead to the use of opioids and/or benzodiazepines for symptomatic treatment. Consequently, some PLWH may be at-risk for the health harms associated with the co-prescribing of these medications. Given this, the objectives of this study were to first examine the prevalence of opioid and benzodiazepines co-prescribing, and second, to characterize patient factors associated with the co-prescribing of opioids and benzodiazepines among PLWH in British Columbia (BC), Canada. Methods: Using data derived from a longitudinal BC cohort, we used bivariable and multivariable generalized estimating equation models to establish the prevalence of a benzodiazepine and opioid co-prescription and determine factors associated with this practice. Results: Between 1996 and 2015, 14 484 PLWH were included in the study and were followed positively associated with concurrent opioid and benzodiazepine prescribing included: depression/ mood disorder [adjusted odds ratio (AOR) = 1.32; 95% confidence interval (CI) = 1.22-1.43] and anxiety disorder (AOR = 1.45; 95% CI = 1.27-1.66), whereas female sex (AOR = 0.76; 95% CI = 0.64-0.91) and substance use disorder (SUD) (AOR = 0.82; 95% CI = 0.74-0.90) were negatively associated with the outcome. Conclusion: Our findings indicate that co-prescription of opioids and benzodiazepines was seen at some point during study follow-up in over a quarter of PLWH. Given the known risks associated with this prescribing practice, future research can focus on the outcomes of co-prescribing among this patient population and the development of strategies to reduce the co-prescribing of opioids and benzodiazepines.

Schizophrenia is a severe mental illness with important implications for morbidity and mortality. This population-based cohort study examined the impact of schizophrenia diagnoses on all-cause mortality among a sample of people living with HIV (PLHIV) and a 10% random sample of individuals living without HIV (HIV-) in British Columbia (BC), through a data linkage between the BC Centre for Excellence in HIV/AIDS and Population Data BC's data holdings. Schizophrenia diagnoses were identified via International Classification of Diseases version 9 and version 10 codes. Age- and sex-adjusted all-cause mortality rates from January 1st, 1998 to December 31st, 2012 were calculated. Multivariable logistic models assessed (1) HIV status and mortality among individuals diagnosed with schizophrenia, (2) schizophrenia diagnosis and mortality among PLHIV, and (3) correlates of mortality among PLHIV concurrently diagnosed with schizophrenia (HIV+/SZO+). From 1998 to 2012, 6.3% of those with HIV had a schizophrenia diagnosis, compared to 1.1% of those without HIV. While significant declines in mortality rates were observed throughout the study period, mortality rates were highest among HIV +/SZO+. After adjustment for substance use disorder and age at baseline, HIV+/SZO+ had a 2.64 times greater odds of mortality (95% confidence interval [CI] = 2.14-3.25) compared to HIV-/SZO+. For PLHIV, a schizophrenia diagnosis was not associated with mortality after controlling for potential confounders (adjusted odds ratio [aOR] = 0.90, 95%CI = 0.74-1.09). Among HIV+/SZO+, age, history of injection drug use, ever having an AIDS-defining illness, and never being on anti-psychotic medication or accessing psychiatric services were associated with mortality. Efforts should be made to identify and link to care individuals disproportionately affected by schizophrenia and excess mortality, including those living with HIV. (C) 2019 Elsevier B.V. All rights reserved.

Background We examined trends and determinants of unsuppressed VL among PLWH stratified on the basis of HIV exposure category over 10 years in BC, Canada. Methods The analysis included all PLWH in BC from 04/2005 to 03/2016 identified in the provincial STOP-HIV database. This database includes: positive HIV test results, antiretroviral therapy (ART) dispensing information, laboratory data, physician billing data, hospital discharge abstracts and vital statistics linkages. For each year, individuals were classified as having an unsuppressed VL if they: 1) were newly diagnosed; 2) had any VL ≥200 copies/mL measure; or 3) did not have a VL measured. We examined factors associated with unsuppressed VL using generalized estimating equations to build a multivariable logistic regression model. Results Among 9778 PLWH in BC during the study period, 80.7% were male and the median age at diagnosis was 37 years. Among those with HIV exposure information, 49.0% were men who have sex with men(MSM), 33.6% were people who use injection drugs(PWID), 16.0% had only heterosexual exposures and 1.4% had other exposures. 16.4% had missing exposure information. The proportion of those with unsuppressed VL decreased from 66.5% in 2005 to 24.5% in 2015 (p<0.001, test of trend). Among MSM, unsuppressed VL declined from 60.0% to 19.8%; among PWID from 75.6% to 33.3% and among heterosexuals from 62.0% to 24.5%. In the multivariate model, PWID (aOR=1.72; 95% CI 1.58–1.88) and heterosexuals (aOR=1.20; 95% CI 1.10–1.32) had increased odds of unsuppressed VL, compared to MSM. Age, sex, year ART initiation, ethnicity, health authority residence and hepatitis C antibody status were also associated with unsuppressed VL (p<0.01 for all). Conclusion Across BC, the proportion of PLWH with unsuppressed VL fell markedly between 2005 - 2015 from 66% to 25%. However, PWID and those with heterosexual exposures require additional supports to maximize the benefits of ART. Disclosure No significant relationships.