The effect of injecting drug use history on disease progression and death among HIV‐positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis
Year: 2011
Type: article
Abstract: BACKGROUND: We examined whether determinants of disease progression and causes of death differ between injecting drug users (IDUs) and non-IDUs who initiate combination antiretroviral therapy (cART). METHODS: The ART Cohort Collaboration combines data from participating cohort studies on cART-naïve adults from cART initiation. We used Cox models to estimate hazard ratios for death and AIDS among IDUs and non-IDUs. The cumulative incidence of specific causes of death was calculated and compared using methods that allow for competing risks. RESULTS: Data on 6269 IDUs and 37 774 non-IDUs were analysed. Compared with non-IDUs, a lower proportion of IDUs initiated cART with a CD4 cell count <200 cells/μL or had a prior diagnosis of AIDS. Mortality rates were higher in IDUs than in non-IDUs (2.08 vs. 1.04 per 100 person-years, respectively; P<0.001). Lower baseline CD4 cell count, higher baseline HIV viral load, clinical AIDS at baseline, and later year of cART initiation were associated with disease progression in both groups. However, the inverse association of baseline CD4 cell count with AIDS and death appeared stronger in non-IDUs than in IDUs. The risk of death from each specific cause was higher in IDUs than non-IDUs, with particularly marked increases in risk for liver-related deaths, and those from violence and non-AIDS infection. CONCLUSION: While liver-related deaths and deaths from direct effects of substance abuse appear to explain much of the excess mortality in IDUs, they are at increased risk for many other causes of death, which may relate to suboptimal management of HIV disease in these individuals.
Source: HIV Medicine
Institutions: University of British Columbia, Simon Fraser University, BC Centre for Excellence in HIV/AIDS, University of Bristol, Inserm, Assistance Publique – Hôpitaux de Paris, Hôpital Avicenne, Université Pierre-et-Marie-Curie, Université Bordeaux Segalen, University of Milan, Hospital Universitari Germans Trias i Pujol, University of Calgary, Amsterdam UMC Location University of Amsterdam, Amsterdam Institute for Global Health and Development, University of Amsterdam, Yale University, Hvidovre Hospital, University of Alabama at Birmingham, UAB Medicine, University College London, University of Zurich, University of Bonn, Goethe University Frankfurt, University Hospital Frankfurt
Language: English
Topic: HIV, Drug Use, Sexual Risk
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: National Science Foundation, Styrelsen för Internationellt Utvecklingssamarbete, Office of Research and Development, Michael Smith Health Research BC, National Institute for Health and Care Research, European Commission, Institut National de la Santé et de la Recherche Médicale, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Universiteit van Amsterdam, China Scholarship Council, Stichting HIV Monitoring, Canadian Institutes of Health Research, Medical Research Council, Instituto de Salud Carlos III, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse
Awards: Prognosis of HIV-positive patients treated with antiretroviral therapy: comparative analyses and treatment strategies, NIHR Senior Investigator Award, 2/6 COMpAAAS U01: Observation Study, Modeling different strategies to reduce the public health impact of the HCV/HIV e, G6807443617, G7965031981, G8382403089
OpenAlex ID: W1687356302