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

Monday 1 October 2012

Spillane H Nicholas S Tang Z Szumilin E Balkan S Pujades-Rodriguez M

Tropical medicine & international health : TM & IH 2012 Oct ; 17(10); 1255-63. doi: 10.1111/j.1365-3156.2012.03056.x. Epub 2012 08 05

HIV VIH antiretroviral therapy cohort study estudio de cohortes facteur de risque factores de riesgo injecting drug use mortalidad mortality mortalité risk factor terapia antirretroviral thérapie antirétrovirale usage de drogues injectables uso de drogas inyectables étude de cohorte

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

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.

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