Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy

Poundstone, Katharine; Chaisson, Richard E.; Moore, Richard D.

doi:10.1097/00002030-200106150-00006

Cited by 157 publications

(91 citation statements)

References 22 publications

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“…Some studies showed that CD4+ T-cell count, viral load, and IDU were predictors of survival time. These studies were consistent with our finding, in which CD4+ T-cell count less than 200 was significant effect on survival, but in-contrast with our result, IDU was not independent statistically significant predictor of mortality [22][23][24]. Based on the study conducted by Larsen et al, the risk of HIV-related death was not increased in IDUs compared to non-IDUs.…”

Section: Discussionsupporting

confidence: 92%

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

Maracy¹,

Mostafaei²,

Moghoofei³

et al. 2017

HIV & AIDS Review

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Section: Discussionsupporting

confidence: 92%

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

Maracy¹,

Mostafaei²,

Moghoofei³

et al. 2017

HIV & AIDS Review

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“…Furthermore, in vitro and animal studies found immunosuppressive effects of opiates, cocaine and other illicit substances [24][25][26][27][28][29][30]. Since 1996, combination ART has largely determined the outcome of HIV infection in patients with access to care [16], and mortality was found to be substantially reduced after the introduction of potent ART also among IDUs [31][32][33]. Therefore, drug addiction treatment programmes, which make access to somatic care possible, appear to be an important prerequisite for improved outcome of ART.…”

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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“…While other studies have demonstrated the negative effect of alcohol 24 and illicit drugs on access to and adherence with ART, [25][26][27][28][29][30][31][32][33] this small pilot study suggests that gaining access to ART in a trusted setting may promote positive health behaviors (e.g., seeking and gaining access to drug treatment) and result in improved health outcomes among active drug users. In our study, the proportion of individuals who achieved an HIV-1 RNA level below the level of detection and an increase of the CD4 lymphocytes count is similar to results obtained in clinical trials in highly selected non-IDU patients.…”

Section: Discussionmentioning

confidence: 73%

Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

Altice

Springer

Buitrago

et al. 2003

Journal of Urban Health: Bulletin of the New York Academy of Me

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Differences in HIV disease progression by injection drug use and by sex in the era of highly active antiretroviral therapy

Abstract: Disease-free survival time was extended with the use of HAART, but these gains were not equally distributed by sex and IDU in our cohort.

Cited by 157 publications

References 22 publications

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

Impact of HIV risk factors on survival in Iranian HIV-infected patients: A Bayesian approach to retrospective cohort

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

Pilot Study to Enhance HIV Care Using Needle Exchange-Based Health Services for Out-of-Treatment Injecting Drug Users

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