{"id":2115,"date":"2007-10-02T18:27:28","date_gmt":"2007-10-02T18:27:28","guid":{"rendered":"http:\/\/moomango.co.uk\/htb\/?p=2115"},"modified":"2013-09-12T16:18:35","modified_gmt":"2013-09-12T16:18:35","slug":"survival-of-hiv-positive-idus-in-the-era-of-haart","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/2115","title":{"rendered":"Survival of HIV-positive IDUs in the era of HAART"},"content":{"rendered":"

Polly Clayden, HIV i-Base<\/strong><\/p>\n

Mortality rates among injection drug users (IDUs) have been historically high and are still significantly higher than the rates for the general population. HIV-positive IDUs have an additional increase in mortality risk.<\/strong><\/p>\n

A paper authored by Roberto Muga and coworkers from the Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, and Department of Statistics and Operations Research, Universitat Polite`cnica de Catalunya, Barcelona, Spain, published in the 1 August 2007 edition of Clinical Infectious Diseases, looked at survival of HIV-positive IDU in the era of HAART.<\/p>\n

In this study they evaluated the mortality rates for a cohort of HIV-positive and negative IDUs who were admitted to a substance abuse treatment programme in a tertiary hospital between January 1987 and December 2004. The investigators divided the follow up period into: 1987-1991 (the antiretroviral monotherapy era), 1992-1996 (the dual-combination treatment era and the introduction of methadone maintenance), and 1997-2004 (the era of HAART and established methadone programmes).<\/p>\n

The investigators noted that during follow-up, several IDUs who were HIV-negative at admission became HIV-positive. They defined the time of infection by the midpoint of the interval from the last negative test result to the first positive test result.<\/p>\n

People that seroconverted contributed survival times to both groups of HIV infection: as seronegative subjects, the (rightcensored) survival time lasted from admission until HIV infection; as seropositive subjects, the survival time lasted from the duration after admission to HIV infection, until either death or the end of follow-up.<\/p>\n

During the study period,1209 IDUs were admitted for the first time to a substance use treatment programme. Twenty-eight (2.3%) of the total study group were excluded from the study cohort because their HIV status was unknown. The calendar periods of admission, for the remaining 1181 IDU included were as follows: 490 (41.5%) for 1987-1991, 393 (33.3%) for 1992-1996 and 298 (25.2%) for 1997-2004.<\/p>\n

The majority (81.3%) of patients were men. The mean age was 27.8 (+\/- 5.6) years, and the mean duration of injection drug use was 7.6 (+\/-5.0) years. The prevalence of HIV infection and hepatitis C virus infections was 59.0% and 92.3%, respectively, and the total duration of follow-up was 10,116 person-years.<\/p>\n

The investigators reported that although survival duration for HIV-negative IDUs in 1997\u00962004 was similar to the duration in earlier periods, the duration for HIV-infected IDUs improved significantly since 1997 (p=0.01). Additionally, among patients admitted in the last period, there was no significant difference between the survival durations for HIV-uninfected and HIVinfected IDUs (HR 0.89; 95%; CI 0.44\u00961.81).<\/p>\n

They found that survival for HIV-positive IDUs improved substantially since 1997, reaching similar rates to those for HIVnegative IDUs who accessed the health care system in the era of HAART and methadone.<\/p>\n

They noted that because only one-third of the HIV-positive IDUs in this study received HAART, other factors are likely to have contributed to their improved survival including: access to substitution therapy with methadone, prophylaxis for opportunistic infections, harm reduction interventions, and regular clinical care.<\/p>\n

They wrote: \u0093HAART has been proven to be an extremely effective therapy for HIV-infected individuals. We have shown that HIV-infected IDUs who received health care during the period 3 exhibited mortality rates comparable to those for IDUs who were not infected with HIV.\u0094<\/p>\n

Reference:<\/p>\n

Muga R, Langohr K, Tor J et al. Survival of HIV-Infected Injection Drug Users (IDUs) in the Highly Active Antiretroviral Therapy Era, Relative to Sex- and Age-Specific Survival of HIV-Uninfected IDUs. Clinical Infectious Diseases 2007:45, 1 August 2007.<\/p>\n","protected":false},"excerpt":{"rendered":"

Polly Clayden, HIV i-Base Mortality rates among injection drug users (IDUs) have been historically high and are still significantly higher than the rates for the general population. HIV-positive IDUs have an additional increase in mortality risk. A paper authored by …<\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[],"class_list":["post-2115","post","type-post","status-publish","format-standard","hentry","category-treatment-access"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2115","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=2115"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/2115\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=2115"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=2115"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=2115"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}