January 14, 2008
It remains unclear whether HIV-infected injection drug users (IDUs) in the era of highly active antiretroviral therapy (HAART) have durations of survival similar to those for comparable HIV-uninfected IDUs. The aim of the current study was to compare survival durations of these two groups of IDUs from 1987 to 2004.
The researchers obtained demographic data, drug use characteristics, and biological markers at the time of admission to a substance abuse treatment program. Duration of survival after admission was the outcome of interest, and the primary exposure was HIV infection. Vital status was obtained via the mortality register by the end of 2004. Three calendar periods, which were defined on the basis of use of specific therapies were examined: 1987-1991 (the antiretroviral monotherapy era), 1992-1996 (the dual combination therapy era, and the era when methadone was introduced in Spain), and 1997-2004 (the era of HAART and of established methadone programs). Cox regression methods allowing for late entries to handle the contribution of persons who survived a given period and entered the following period with nonzero time were used. HIV-infected and -uninfected IDUs were compared with adjustments for age, sex, and duration of follow-up after admission.
From January 1987 to December 2004, 1,209 IDUs were admitted to the hospital, of whom 1,181 were eligible for the study. The majority (81.3 percent) were men. Mean age (± standard deviation) at admission was 27.8 ± 5.6 years, and the mean duration of injection drug use (± standard deviation) was 7.6 ± 5.0 years. Prevalence of HIV and hepatitis C infections was 59.0 percent and 92.3 percent, respectively. The total duration of follow-up was 10.116 person-years. While survival duration for HIV-uninfected IDUs in 1997-2004 was similar to the duration in previous periods, the duration for HIV-infected IDUs improved significantly since 1997 (P<.01 in addition among patients admitted the last period survival durations for hiv-infected and idus were essentially same hazard percent confidence interval>"The duration of survival of HIV-infected IDUs has improved substantially since 1997, reaching rates similar to the rates for HIV-seronegative IDUs who accessed the health care system in the era of HAART," the authors concluded.
Clinical Infectious Diseases
8.01.2007; Vol. 45: P. 370-376; Roberto Muga, Klaus Langohr, Jordi Tor, Arantza Sanvisens, Isabel Serra, Celestino Rey-Joly, Álvaro Muñoz
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