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The effect of injecting drug use history on disease progression and death among HIV‐positive individuals initiating combination antiretroviral therapy: collaborative cohort analysis
Author(s) -
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 JAC
Publication year - 2012
Publication title -
hiv medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.53
H-Index - 79
eISSN - 1468-1293
pISSN - 1464-2662
DOI - 10.1111/j.1468-1293.2011.00940.x
Subject(s) - medicine , antiretroviral therapy , human immunodeficiency virus (hiv) , cohort , drug , disease , cohort study , antiretroviral drug , injection drug use , viral load , immunology , pharmacology , drug injection
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.