Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti‐retroviral treatment and higher mortality

Suárez‐García, Inés; Sobrino-Vegas, Paz; Dalmau, David; Rubio, Rafael; Iribarren, José Antonio; Blanco, José Ramón; Gutiérrez, Félix; Montero, Marta; Bernal, Enrique; García, David Vinuesa; Amo, Julia del

doi:10.1111/add.13348

Cited by 29 publications

(20 citation statements)

References 45 publications

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“…Recent data from The Joint United Nations Programme on HIV/AIDS described a 19% decline in AIDS-related deaths from 2011 to 2014, and a 35% decline from 2005 to 2014 [1**]. Among HIV-positive PWID however, the leading cause of death remains HIV/AIDS-related causes [2,3**,7,29,30,31*,32–34,35*,36**,37], reflecting suboptimal levels of ART access, and adherence in this population.…”

Section: Hiv/aids-related Mortality In the Modern Treatment Eramentioning

confidence: 99%

“…Research has underscored the impact of liver-related diseases [2,11,30,31*,50], including hepatitis C virus (HCV) [7,34,51], on premature mortality among HIV-positive PWID, with HIV – HCV co-infected individuals having a significantly increased risk of death [11]. A 15-year prospective cohort study investigating predictors of liver-related death in a cohort of PWID in Vancouver showed that HIV seropositivity was independently and positively associated with liver-related mortality [31*].…”

Section: Addressing Hepatitis C Virus- Related Mortalitymentioning

confidence: 99%

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Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Parashar

Collins

Montaner

et al. 2016

Current Opinion in HIV and AIDS

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Purpose of review The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. Recent findings The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social–structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. Summary The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.

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Section: Hiv/aids-related Mortality In the Modern Treatment Eramentioning

confidence: 99%

Section: Addressing Hepatitis C Virus- Related Mortalitymentioning

confidence: 99%

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Parashar

Collins

Montaner

et al. 2016

Current Opinion in HIV and AIDS

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“…Suárez-García I et al, reported patients who acquired HIV by sexual transmission compared with who acquired HIV infection through use of injected drugs has higher risk of late presentation, delayed antiretroviral therapy (ART) initiation, higher mortality and risk of progression to AIDS [33]. Therefore, in examining the risk factors for AIDS, it is also important to pay attention to the mediator factors; which can reduce or increase DALYs and mortality rate attributed to AIDS.…”

Section: Discussionmentioning

confidence: 99%

Disability-Adjusted Life Years (DALYs) and Mortality Rate Attributed to Unsafe Sex and Drug Use for AIDS in the Middle East and North Africa Countries

Najafi

Khosravi

Ghalandari

et al. 2020

Preprint

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Background: To reduce the burden of HIV/AIDS, it is important to identify and estimate the attributable burden of risk factors associated with HIV/AIDS. The present study aimed to estimate the attributable burden of unsafe sex and drug use in AIDS in the Middle East and North Africa (MENA) countries. Methods: We used the data in Global Burden of Disease (GBD) 2017 to estimate the attributable burden of unsafe sex and drug use in AIDS in the MENA (22 countries) from 1990 to 2017 by sex and age. We estimated the attributable mortality and disability-adjusted life-years (DALYs) for the mentioned risk factors.Results: The rate of DALYs/100,000 attributed to drug use for AIDS increased 1.10 (95% CI: 0.75-1.71) to 13.39 (95% CI: 9.98- 18.17) in women of MENA countries from 1990 to 2017, and there is an increasing trend in DALY attributable to drug use for AIDS in men. The rate of DALYs/100,000 attributed to unsafe sex for AIDS increased in women of MENA countries, 5.15 (95% CI: 3.34-8.07) to 53.44 (95% CI: 38.79-75.89); and 10.06 (95% CI: 6.61-16.18) to 46.16 (95% CI: 31.30-72.66) in men. Age-standardized mortality rate attributed to drug use and unsafe sex for AIDS increased from 1990 to 2017 in both sex in MENA.Conclusion: The rate of DALYs/100,000 and age-standardized mortality rate attributed to unsafe sex and drug use increased in MENA from 1990 to 2017. While most of such countries have traditional cultures with religious believes, such increase need to be addressed in more depth by all policy makers.

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“…The tension between public health and criminal justice system approaches to HIV prevention is arguably most acutely felt by marginalized and otherwise criminalized groups, including PLWH who use illicit drugs. Studies consistently show that exposure to the criminal justice system is one of the most important barriers to engagement with HIV treatment and care (Cescon et al, 2011; Small, Kerr, Charette, Schechter, & Spittal, 2006, Suárez-García et al, 2016; Werb et al, 2008). People who use illicit drugs confront intersecting axes of disadvantage and stigma, experience high levels of surveillance from the criminal justice system, and face considerable social and structural barriers to retention in HIV treatment and care (Cescon et al, 2011; Kuchinad et al, 2016; Small et al, 2006; Suárez-García et al, 2016; Werb et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting

Patterson

Kaida

Hogg

et al. 2017

International Journal of Drug Policy

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Background In 2012, the Supreme Court of Canada (SCC) ruled that people living with HIV (PLWH) could face criminal charges if they did not disclose their serostatus before sex posing a “realistic possibility” of HIV transmission. Condom-protected vaginal sex with a low (i.e., <1500 copies/mL) HIV viral load (VL) incurs no duty to disclose. Awareness and understanding of this ruling remain uncharacterized, particularly among marginalized PLWH. Methods We used data from ACCESS, a community-recruited cohort of PLWH who use illicit drugs in Vancouver. The primary outcome was self-reported awareness of the 2012 SCC ruling, drawn from cross-sectional survey data. Participants aware of the ruling were asked how similar their understanding was to a provided definition. Sources of information from which participants learned about the ruling were determined. Multivariable logistic regression identified factors independently associated with ruling awareness. Results Among 249 participants (39% female), median age was 50 (IQR: 44–55) and 80% had a suppressed HIV VL (<50 copies/mL). A minority (112, 45%) of participants reported ruling awareness, and 44 (18%) had a complete understanding of the legal obligation to disclose. Among those aware (n = 112), newspapers/media (46%) was the most frequent source from which participants learned about the ruling, with 51% of participants reporting that no healthcare providers had talked to them about the ruling. Ruling awareness was negatively associated with VL suppression (AOR:0.51, 95% CI:0.27,0.97) and positively associated with recent condomless sex vs. no sex (AOR:2.00, 95% CI:1.03,3.92). Conclusion Most participants were not aware of the 2012 SCC ruling, which may place them at risk of prosecution. Discussions about disclosure and the law were lacking in healthcare settings. Advancing education about HIV disclosure and the law is a key priority. The role of healthcare providers in delivering information and support to PLWH in this legal climate should be further explored.

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Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti‐retroviral treatment and higher mortality

Abstract: In Spain, patients who acquire HIV infection through use of injected drugs appear to have a higher risk of late presentation, delayed initiation of anti-retroviral treatment and progression to AIDS and death than patients who acquire HIV by sexual transmission.

Cited by 29 publications

References 45 publications

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Disability-Adjusted Life Years (DALYs) and Mortality Rate Attributed to Unsafe Sex and Drug Use for AIDS in the Middle East and North Africa Countries

Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting

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