The effect of injecting drug use history on disease progression and death among HIV‐positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis

HIV Medicine - Tập 13 Số 2 - Trang 89-97 - 2012
Milena M. McLaughlin1, Robert S. Hogg2,3, VD Lima2, Margaret May4, David Moore2,5, Sophie Matheron6,7,8, Mathias Bruyand9, Antonella d’Arminio Monforte10, C. Tural11, M. John Gill12, R I Harris13, Peter Reiss14, Amy C. Justice15, Ole Kirk16, Michael Ohl17, Colette Smith18, Rainer Weber19, Jürgen K. Rockstroh20, Pavel Khaykin21, Jonathan A C Sterne4
1Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
2Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
3Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
4School of Social and Community Medicine, University of Bristol, Bristol, UK
5Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
6AP-HP, Avicenne Hospital, Service for Infectious and Tropical Diseases, Bobigny, France
7INSERM u943, Paris, France
8UPMC University Paris 06, UMR_S 943, Paris, France
9INSERM, U593, Victor Segalen University, Bordeaux, France
10Clinic of Infectious Diseases & Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy
11University Hospital of Germans I Pujol, Barcelona, Spain
12Division of Infectious Diseases, University of Calgary, Calgary, Canada
13Health Protection Agency, Colindale, London, UK
14Center for Infection and Immunity Amsterdam and Center for Poverty-related Communicable Diseases, Amsterdam Institute for Global Health and Development, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
15Yale University School of Medicine, New Haven, CT, USA
16Department of Infectious Diseases, Hvidovre University Hospital, Hvidovre, Denmark
17Division of Infectious Disease, Department of Medicine, University of Alabama, Birmingham, AL, USA
18UCL Medical School, London, UK
19Division of Infectious Diseases and Hospital Epidemiology, University of Zurich, Zurich, Switzerland
20Department of Medicine, University of Bonn, Bonn, Germany
21HIV Treatment and Clinical Research Unit, Hospital of the J. W. Goethe University, Frankfurt, Germany

Tóm tắt

BackgroundWe 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).MethodsThe 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.ResultsData 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.ConclusionWhile 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.

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HIV Medicine

Tập 13 Số 2

89-97

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