A poster from Sadr and colleagues examined the rates and causes of mortality in a cohort of 204 IDUs taking HAART between January 1998 and June 2007 (1,032 person years).

Mean age at enrolment was 40.8 years, 150 (74%) were males, 107 (52%) were Aboriginal, and all were current or previous injection drug users.

There were 65 deaths for a cumulative mortality of 34.6% (annual mortality rate of 5.3%). Mean age at time of death was 42.5 years (44.1 yrs for males, 37.9 yrs for females). The cause of death was HIV-related in 36 (55%) cases, including AIDS without a specific pathological diagnosis (17); community-acquired pneumonia (5), tuberculosis (3), cryptococcal meningitis (2), mycobacterium avium-complex (2), lymphoma (2), PCP pneumonia (2), PML (2), and Kaposi’s Sarcoma (1). The 29 (45%) deaths not directly HIV-related included end-stage liver disease (9), drug overdose (6), cardiovascular disease (6), stroke (2), suicide (2), chronic lung disease (1), endocarditis (1), cancer (1), and undetermined (1). At the time of death, the mean CD4 count was 198 cells/mm3 and 23% had a plasma viral load less than 50 copies/ml.

The researchers concluded that despite HAART, mortality rates remained extremely high. In addition to a wide range of HIV related opportunistic infections, non-HIV related events accounted for nearly half of the deaths. Renewed efforts are needed to engage drug users in HIV care and address the social, environmental and addiction-related factors that contribute to these preventable and pre-mature deaths.

Ref:
Sadr A et al. Causes of mortality among injection drug users enrolled in an antiretroviral program in Vancouver, Canada. MOPO0253.
http://www.aids2008.org/Pag/Abstracts.aspx?AID=7351