Antiretroviral therapy use and CD4 cell count among people who inject drugs living with HIV in southern Vietnam

OBJECTIVES: People who inject drugs (PWID) are central to the HIV epidemic in Vietnam, many delay HIV testing and antiretroviral therapy (ART) until advanced disease. We assessed prevalence and correlates of ART use and low CD4 counts among PWID with HIV. SETTING: Analysis of the 2013 Integrated Behavioral and Biologic Survey in Vietnam. METHODS: Eligible participants were men aged ≥ 18 years who reported recent injecting, were HIV positive, and consented to future viral load (VL) and CD4 testing. Undetectable VL was defined as < 50 copies/ml. Percentages and prevalences were adjusted for sampling method. RESULTS: Of 287 PWID, 55% knew their status. Among these, 88% were on ART, and 82% had undetectable VL. ART use was positively associated with older age (> 40 vs. < 30 years, OR 4.9, 95% CI 1.2-20.5) and opioid substitution therapy (OR 12.7, 95% CI 1.1-141.7). It was negatively associated with living alone (OR 0.1, 95% CI 0.0-0.5), living with a partner versus relatives (OR 0.3, 95% CI 0.1-0.8), higher income (> VND 4.5 vs. < 2.5 million; OR 0.2, 95% CI 0.1-0.7), and recent rehabilitation (OR 0.2, 95% CI 0.1-0.8). Among those not on ART, 16% had CD4 < 200 cells/mm³; longer injecting duration was strongly associated (OR 6.3 for > 10 vs. < 5 years, 95% CI 1.5-27.3). CONCLUSIONS: Suboptimal HIV status awareness, ART uptake, and advanced immunosuppression among untreated PWID highlight the need for strengthened case finding and earlier engagement. Linking treatment, social support, and HIV services in closed settings could improve outcomes.