Incidence, risk factors and causes of death in an HIV care programme with a large proportion of injecting drug users.

Hdl Handle:
http://hdl.handle.net/10144/255354
Title:
Incidence, risk factors and causes of death in an HIV care programme with a large proportion of injecting drug users.
Authors:
Spillane, Heidi; Nicholas, Sarala; Tang, Zhirong; Szumilin, Elisabeth; Balkan, Suna; Pujades-Rodriguez, Mar
Journal:
Tropical Medicine & International Health
Abstract:
Objectives  To identify factors influencing mortality in an HIV programme providing care to large numbers of injecting drug users (IDUs) and patients co-infected with hepatitis C (HCV). Methods  A longitudinal analysis of monitoring data from HIV-infected adults who started antiretroviral therapy (ART) between 2003 and 2009 was performed. Mortality and programme attrition rates within 2 years of ART initiation were estimated. Associations with individual-level factors were assessed with multivariable Cox and piece-wise Cox regression. Results  A total of 1671 person-years of follow-up from 1014 individuals was analysed. Thirty-four percent of patients were women and 33% were current or ex-IDUs. 36.2% of patients (90.8% of IDUs) were co-infected with HCV. Two-year all-cause mortality rate was 5.4 per 100 person-years (95% CI, 4.4-6.7). Most HIV-related deaths occurred within 6 months of ART start (36, 67.9%), but only 5 (25.0%) non-HIV-related deaths were recorded during this period. Mortality was higher in older patients (HR = 2.50; 95% CI, 1.42-4.40 for ≥40 compared to 15-29 years), and in those with initial BMI < 18.5 kg/m(2) (HR = 3.38; 95% CI, 1.82-5.32), poor adherence to treatment (HR = 5.13; 95% CI, 2.47-10.65 during the second year of therapy), or low initial CD4 cell count (HR = 4.55; 95% CI, 1.54-13.41 for <100 compared to ≥100 cells/μl). Risk of death was not associated with IDU status (P = 0.38). Conclusion  Increased mortality was associated with late presentation of patients. In this programme, death rates were similar regardless of injection drug exposure, supporting the notion that satisfactory treatment outcomes can be achieved when comprehensive care is provided to these patients.
Affiliation:
Médecins Sans Frontières, Nanning, China;Epicentre, Paris, France; Guangxi Centre for Disease Control, Nanning, China; Médecins Sans Frontières, Paris, France.
Issue Date:
5-Aug-2012
URI:
http://hdl.handle.net/10144/255354
DOI:
10.1111/j.1365-3156.2012.03056.x
PubMed ID:
22863110
Type:
Article
Language:
en
ISSN:
1365-3156
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorSpillane, Heidien_GB
dc.contributor.authorNicholas, Saralaen_GB
dc.contributor.authorTang, Zhirongen_GB
dc.contributor.authorSzumilin, Elisabethen_GB
dc.contributor.authorBalkan, Sunaen_GB
dc.contributor.authorPujades-Rodriguez, Maren_GB
dc.date.accessioned2012-12-11T21:03:44Z-
dc.date.available2012-12-11T21:03:44Z-
dc.date.issued2012-08-05-
dc.identifier.citationTrop Med Int Health 2012; Epub ahead of print.en_GB
dc.identifier.issn1365-3156-
dc.identifier.pmid22863110-
dc.identifier.doi10.1111/j.1365-3156.2012.03056.x-
dc.identifier.urihttp://hdl.handle.net/10144/255354-
dc.description.abstractObjectives  To identify factors influencing mortality in an HIV programme providing care to large numbers of injecting drug users (IDUs) and patients co-infected with hepatitis C (HCV). Methods  A longitudinal analysis of monitoring data from HIV-infected adults who started antiretroviral therapy (ART) between 2003 and 2009 was performed. Mortality and programme attrition rates within 2 years of ART initiation were estimated. Associations with individual-level factors were assessed with multivariable Cox and piece-wise Cox regression. Results  A total of 1671 person-years of follow-up from 1014 individuals was analysed. Thirty-four percent of patients were women and 33% were current or ex-IDUs. 36.2% of patients (90.8% of IDUs) were co-infected with HCV. Two-year all-cause mortality rate was 5.4 per 100 person-years (95% CI, 4.4-6.7). Most HIV-related deaths occurred within 6 months of ART start (36, 67.9%), but only 5 (25.0%) non-HIV-related deaths were recorded during this period. Mortality was higher in older patients (HR = 2.50; 95% CI, 1.42-4.40 for ≥40 compared to 15-29 years), and in those with initial BMI < 18.5 kg/m(2) (HR = 3.38; 95% CI, 1.82-5.32), poor adherence to treatment (HR = 5.13; 95% CI, 2.47-10.65 during the second year of therapy), or low initial CD4 cell count (HR = 4.55; 95% CI, 1.54-13.41 for <100 compared to ≥100 cells/μl). Risk of death was not associated with IDU status (P = 0.38). Conclusion  Increased mortality was associated with late presentation of patients. In this programme, death rates were similar regardless of injection drug exposure, supporting the notion that satisfactory treatment outcomes can be achieved when comprehensive care is provided to these patients.en_GB
dc.languageENG-
dc.language.isoenen
dc.rightsArchived on this site with the kind permission of Wiley-Blackwell, [url]http://www.blackwell-synergy.com/loi/tmi[/url]en_GB
dc.subjectCholeraen_GB
dc.titleIncidence, risk factors and causes of death in an HIV care programme with a large proportion of injecting drug users.en
dc.typeArticleen
dc.contributor.departmentMédecins Sans Frontières, Nanning, China;Epicentre, Paris, France; Guangxi Centre for Disease Control, Nanning, China; Médecins Sans Frontières, Paris, France.en_GB
dc.identifier.journalTropical Medicine & International Healthen_GB

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