Impact of HAART and injection drug use on life expectancy of two HIV-positive cohorts in British Columbia

Lloyd‐Smith, Elisa; Brodkin, Elizabeth; Wood, Evan; Kerr, Thomas; Tyndall, Mark W.; Montaner, Julio S. G.; Hogg, Robert S.

doi:10.1097/01.aids.0000206508.32030.92

Cited by 59 publications

(36 citation statements)

References 22 publications

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“…Other factors, which were not assessed in our current study but may contribute to inferior virological outcome, may include poverty [38], lack of family support [39], alcohol use [37], smoking, depression [40,41], and psychiatric comorbidity [42]. Virological failure and failure of addiction treatment programmes among HIV-infected IDUs result in increased morbidity and mortality [19,31,[42][43][44][45].…”

Section: Discussionmentioning

confidence: 99%

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

et al. 2009

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ObjectivesThe aim of the study was to investigate the influence of continued injecting drug use, enrolment in an opiate substitution treatment programme (OSTP), or cessation of injecting drug use on the uptake and course of antiretroviral therapy (ART). DesignA prospective observational study of all participants in the Swiss HIV Cohort Study followed between 1997 and 2006 was carried out. MethodsWe distinguished four groups of former or current injecting drug users (IDUs): (i) abstinent former IDUs; (ii) persons in OSTPs without concomitant injecting drug use; (iii) persons in OSTPs with concomitant injecting drug use; (vi) current IDUs. These groups were compared with a group of patients who had never been IDUs. Factors related to ART uptake and virological endpoints were analysed using logistic generalized estimating equations. ResultsWe followed 8660 participants for 48 477 person-years; 29.7% were in the IDU HIV transmission group. The likelihood of being on ART at biannual visits was lower among individuals in OSTPs with concomitant injecting drug use [odds ratio (OR) 0.79; 95% confidence interval (CI) 0.71-0.89] and current IDUs (OR 0.80; 95% CI 0.67-0.96), compared with those who had never been IDUs (reference), abstinent former IDUs (OR 1.13; 95% CI 1.02-1.25) and individuals in OSTPs without injecting drug use (OR 1.18; 95% CI 1.06-1.31). The likelihood of suppressed viral replication on ART was similar among those who had never been IDUs, abstinent former IDUs and individuals in an OSTP without injecting drug use, and lower among those in OSTPs with concomitant drug use (OR 0.82; 95% CI 0.72-0.93) and current IDUs (OR 0.81; 0.65-1.00). Adherence to ART was decreased among persons with continued injecting drug use, and correlated with virological outcome. [4][5][6][7], the potential for interactions among medication, opiate substitution and illicit drugs [8], adverse effects [9], and limited access to [10,11], delayed use of [10,12,13], and decreased response to treatment [4,7]. As a consequence of such difficulties, physicians may be reluctant to offer ART to HIV-infected IDUs [14,15], resulting in less than optimal care and worse outcome [16,17].In HIV research, the term 'IDU' is commonly used to describe the HIV transmission category or patient characteristics. When investigating the course of HIV infection and the outcome of ART in these patients, however, it is an oversimplification to consider IDUs as a homogenous group. IDUs frequently change their drug injection behaviour, drug addiction treatment status or health care setting [18,19]. We aimed to investigate the influence of injecting drug use behaviour and enrolment in opiate substitution treatment programmes on the uptake of and virological response to ART among persons classified as belonging to the IDU HIV transmission group, and to study the association between injecting drug use behaviour and adherence to ART. We distinguished four distinct groups of former or current IDUs: (i) abstinent former IDUs who had completely stopped injecting d...

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Section: Discussionmentioning

confidence: 99%

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

et al. 2009

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“…is similar to that for other exposure groups, as long as adherence to treatment is satisfactory [9,10]. In Spain, overdose is the primary cause of death among HIV-uninfected substance abusers [11], and AIDS still accounts for an important number of deaths.…”

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confidence: 83%

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

Muga

Langohr

Tor

et al. 2007

Clinical Infectious Diseases

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“…9,10 Additionally, as more is known about how HIV treatment impacts transmissibility of the virus to seronegative partners, 24 it may be that our assumption that duration of transmissibility at the T(x) level is equal to life expectancy is somehow false, and D should be set at less than life expectancy. However, employing this assumption in this model is conservative because as D becomes progressively less than life expectancy, the amount of reduction in T(x) from current levels needed to achieve an R 0 of unity is accordingly lessened.…”

Section: Limitationsmentioning

confidence: 99%

Is the Elimination of HIV Infection within Reach in the United States? Lessons from an Epidemiologic Transmission Model

Holtgrave

2010

Public Health Rep

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SYNOPSISRecent estimates show that the transmission rate of human immunodeficiency virus (HIV) in the U.S. has substantially decreased. This raises the question, is elimination of HIV infection in the nation feasible in the foreseeable future? We demonstrate that if the HIV transmission rate were reduced by 50%, then the reproductive rate of HIV infection would drop below unity and lead to eventual elimination of infection. In recent congressional testimony, the director of the Centers for Disease Control and Prevention and others asserted that the HIV transmission rate can be halved by 2020, if not earlier, provided sufficient investment is made toward achieving this goal. We assert that if adequate investment is made and the transmission rate is in fact lowered by 50%, then the HIV reproductive rate would fall below unity, setting the stage for eventual elimination of HIV infection in the U.S.

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Impact of HAART and injection drug use on life expectancy of two HIV-positive cohorts in British Columbia

Abstract: There are substantial disparities in life expectancy for persons living with HIV in British Columbia. Members of the injection drug community, particularly those who are not taking HAART, experience elevated mortality in comparison with those without a history of drug use.

Cited by 59 publications

References 22 publications

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

Uptake of and virological response to antiretroviral therapy among HIV‐infected former and current injecting drug users and persons in an opiate substitution treatment programme: the Swiss HIV Cohort Study

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

Is the Elimination of HIV Infection within Reach in the United States? Lessons from an Epidemiologic Transmission Model

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