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Impact of injecting drug use on mortality in Danish HIV‐infected patients: a nation‐wide population‐based cohort study
Author(s) -
Larsen Mette V.,
Omland Lars H.,
Gerstoft Jan,
Larsen Carsten S.,
Jensen Janne,
Obel Niels,
Kronborg Gitte
Publication year - 2010
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/j.1360-0443.2009.02827.x
Subject(s) - medicine , cohort , population , confidence interval , cohort study , proportional hazards model , prospective cohort study , hepatitis c , mortality rate , demography , environmental health , sociology
Objectives To estimate the impact of injecting drug use (IDU) on mortality in HIV‐infected patients in the highly active antiretroviral therapy (HAART) era. Design Population‐based, nation‐wide prospective cohort study in Denmark (the Danish HIV Cohort Study). Methods A total of 4578 HIV‐infected patients were followed from 1 January 1997 or date of HIV diagnosis. We calculated mortality rates stratified on IDU. One‐, 5‐ and 10‐year survival probabilities were estimated by Kaplan–Meier methods, and Cox regression analyses were used to estimate mortality rate ratios (MRR). Results Of the patients, 484 (10.6%) were categorized as IDUs and 4094 (89.4%) as non‐IDUs. IDUs were more likely to be women, Caucasian, hepatitis C virus (HCV) co‐infected and younger at baseline; 753 patients died during observation (206 IDUs and 547 non‐IDUs). The estimated 10‐year survival probabilities were 53.2% [95% confidence interval (CI): 48.1–58.3] in the IDU group and 82.1% (95% CI: 80.7–83.6) in the non‐IDU group. IDU as route of HIV infection more than tripled the mortality in HIV‐infected patients (MRR: 3.2; 95% CI: 2.7–3.8). Adjusting for potential confounders did not change this estimate substantially. The risk of HIV‐related death was not increased in IDUs compared to non‐IDUs (MRR 1.1; 95% CI 0.7–1.7). Conclusions Although Denmark's health care system is tax paid and antiretroviral therapy is provided free of charge, HIV‐infected IDUs still suffer from substantially increased mortality in the HAART era. The increased risk of death seems to be non‐HIV‐related and is due probably to the well‐known risk factors associated with intravenous drug abuse.