Incidence, risk factors and causes of death in an HIV care programme with a large proportion of injecting drug users.
AffiliationMédecins Sans Frontières, Nanning, China;Epicentre, Paris, France; Guangxi Centre for Disease Control, Nanning, China; Médecins Sans Frontières, Paris, France.
MetadataShow full item record
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.
- Influence of noninjecting and injecting drug use on mortality, retention in the cohort, and antiretroviral therapy, in participants in the Swiss HIV Cohort Study.
- Authors: Weber R, Huber M, Battegay M, Stähelin C, Castro Batanjer E, Calmy A, Bregenzer A, Bernasconi E, Schoeni-Affolter F, Ledergerber B, Swiss HIV Cohort Study.
- Issue date: 2015 Mar
- The effect of injecting drug use history on disease progression and death among HIV-positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis.
- Authors: Murray M, Hogg RS, Lima VD, May MT, Moore DM, Abgrall S, Bruyand M, D'Arminio Monforte A, Tural C, Gill MJ, Harris RJ, Reiss P, Justice A, Kirk O, Saag M, Smith CJ, Weber R, Rockstroh J, Khaykin P, Sterne JA, Antiretroviral Therapy Cohort Collaboration (ART-CC).
- Issue date: 2012 Feb
- Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study.
- Authors: Larsen MV, Omland LH, Gerstoft J, Larsen CS, Jensen J, Obel N, Kronborg G
- Issue date: 2010 Mar
- Mortality in HIV-seropositive versus -seronegative persons in the era of highly active antiretroviral therapy: implications for when to initiate therapy.
- Authors: Wang C, Vlahov D, Galai N, Bareta J, Strathdee SA, Nelson KE, Sterling TR
- Issue date: 2004 Sep 15
- Uptake of and virological response to antiretroviral therapy among HIV-infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study.
- Authors: Weber R, Huber M, Rickenbach M, Furrer H, Elzi L, Hirschel B, Cavassini M, Bernasconi E, Schmid P, Ledergerber B, Swiss HIV Cohort Study.
- Issue date: 2009 Aug