Mortality among Drug Users in the AIDS Era

Goedert, James J.; Pizza, G; Gritti, Fabrice; Costigliola, Paolo; Boschini, Antonio; Bini, A.; Lazzari, Carlo; Palareti, Aldopaolo

doi:10.1093/ije/24.6.1204

Cited by 26 publications

(29 citation statements)

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“…Goedert et al retrospectively studied mortality in drug users in Italy and found that trauma, overdose, bacterial infections, hepatitis, and cirrhosis were increased in those who were HIV infected (21). One British study, which took place before combination antiretroviral therapy, found that 5% of deaths among HIV-infected persons were due to non-AIDS causes, especially among those who were older or used injection drugs (22).…”

Section: Discussionmentioning

confidence: 99%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

140

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PURPOSE-To examine changes in the causes of death and mortality in women with human immunodeficiency virus (HIV) infection in the era of combination antiretroviral therapy.METHODS-Among women with, or at risk of, HIV infection, who were enrolled in a national study from 1994 to 1995, we used an algorithm that classified cause of death as due to acquired immunodeficiency syndrome (AIDS) or non-AIDS causes based on data from death certificates and the CD4 count. Poisson regression models were used to estimate death rates and to determine the risk factors for AIDS and non-AIDS deaths.RESULTS-Of 2059 HIV-infected women and 569 who were at risk of HIV infection, 468 (18%) had died by April 2000 (451 HIV-infected and 17 not infected). Causes of death were available for 428 participants (414 HIV-infected and 14 not infected). Among HIV-infected women, deaths were classified as AIDS (n = 294), non-AIDS (n = 91), or indeterminate (n = 29). The non-AIDS causes included liver failure (n = 19), drug overdose (n = 16), non-AIDS malignancies (n = 12), cardiac disease (n = 10), and murder, suicide, or accident (n = 10). Allcause mortality declined an average of 26% per year (P = 0.03) and AIDS-related mortality declined by 39% per year (P = 0.01), whereas non-AIDS-related mortality remained stable (10% average annual decrease, P = 0.73). Factors that were independently associated with non-AIDSrelated mortality included depression, history of injection drug use with hepatitis C infection, cigarette smoking, and age.CONCLUSION-A substantial minority (20%) of deaths among women with HIV was due to causes other than AIDS. Our data suggest that to decrease mortality further among HIV-infected women, attention must be paid to treatable conditions, such as hepatitis C, depression, and drug and tobacco use.With the advent of combination antiretroviral therapy, mortality for persons with acquired immunodeficiency disease syndrome (AIDS) in the United States has declined markedly (1-3). For women with AIDS, these declines have been delayed and smaller in magnitude than those seen in men (1,4), perhaps due to racial and sex differences in access to antiretroviral ©2002 by Excerpta Medica, Inc. Although most studies have not found sex-related differences in HIV disease progression (9,10), some have noted a worse prognosis for women, especially those who inject drugs (11,12). Causes of death were not examined in these studies. Assessing causes of death may clarify the effects of other medical problems on mortality of women with HIV infection.The purpose of this investigation was to evaluate cause-specific mortality of participants in the Women's Interagency HIV Study, the largest U.S. longitudinal study of women with HIV infection. We examined non-HIV-related causes of death, compared the changes in mortality between those who died of AIDS and those who died of non-AIDS causes, and compared risk factors for AIDS and non-AIDS mortality in the era of combination antiretroviral therapy. METHODS SampleThe Women's Interagency HIV Study...

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Section: Discussionmentioning

confidence: 99%

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Cohen

French

Benning

et al. 2002

The American Journal of Medicine

140

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“…14,17,19,21,24,32,38,49,52,57,58 In 20 studies CMRs were provided separately for people who inject drugs according to their HIV status. 15,16,18,28,34,[36][37][38][39][40]45,48,49,55,57,60,65,70,72,74 Allcause mortality was three times higher among HIV+ than among HIV− subjects (CMR ratio: 3.15) (Fig. 8).…”

Section: Causes Of Deathmentioning

confidence: 96%

Mortality among people who inject drugs: a systematic review and meta-analysis

Mathers

Degenhardt

Bucello

et al. 2013

Bull. World Health Organ.

392

308

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“…Al comparar los datos que obtuvimos sobre la tasa de mortalidad con los de otros estudios del norte de Italia se comprobó que eran menores que los de Bolonia (18 veces) y Milán (20 veces). 3,5 Por sexos, la diferencia entre la SMR de los ADVP y del conjunto de la población (8.85 en los hombres, 21.71 en las mujeres) no debe atribuirse al aumento de la tasa de mortalidad de las ADVP mujeres. El Indirectly Standardised Rate de los hombres y de las mujeres es parecido (2.56 2.60 respectivamente).…”

Section: Confirmando Estudios Nacionalesunclassified

“…52 Respecto a la tasa de seropositividad al VIH, el único dato significativo es que, si exceptuamos a los pacientes muertos por SIDA, la prevalencia es mayor en los individuos fallecidos por hepatopatías, dato que coincide con los resultados de estudios precedentes. 3,18,53 El estudio no ha revelado que el porcentaje de seropositividad al VIH sea más alto entre los ADVP muertos por sobredosis o suicidio. En este aspecto, algunos estudios confirman nuestros datos, 5,6,18,54 al contrario que otros.…”

Section: Figura 2 Distribución De La Edad Media De Las Muertes Desdeunclassified

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Causas principales de muerte entre 2.708 heroinómanos del noreste italiano (1985-1998)

et al. 2002

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RESUMENObjetivos. Establecer las causas de la muerte acaecidas entre 1985 y 1998 en un numeroso grupo de usuarios de droga por vía intravenosa (ADVP)] acogidos en 36 Servicios Públicos para Toxicomanías (Ser T) del noroeste italiano.Métodos. Estudio realizado sobre datos recogidos en los archivos de los Ser. T y del Registro Municipal de cada una de las ULSS estudiadas.Individuos implicados. Todos los ADVP que hayan pasado por lo menos una vez por uno de los 36 Ser.T. incluidos en el estudio.Resultados. El estudio analizó las causas de la muerte de 2708 individuos. La primera causa de muerte es la sobredosis (37%), seguida del SIDA (32.5%) y de los accidentes de tráfico (9.4%). El porcentaje de muertes causadas por el SIDA aumentó progresivamente, pasando de un 2.7% en 1985 a un 42.2% en 1996, reduciéndose después al 16.9% en 1998. El porcentaje de fallecimientos por sobredosis se mantuvo prácticamente constante durante todo el tiempo. La edad media de la muerte aumentó, pasando de 26 años a mediados de los años 80 a 34 años en 1998. La tasa de mortalidad entre ADVP es 13 veces mayor que en el conjunto de la población (95%, CI 11.3-14.6). En el conjunto de la población el porcentaje de fallecimientos en edades comprendidas entre los 15 y los 34 años atribuida al uso de opiáceos era en 1991 (año del último censo) del 16%. La prevalencia del VIH no resultó estadísticamente significativa en las causas de muerte por suicidio o sobredosis.Conclusiones. Se comprobó que la tasa de mortalidad era 13 veces superior a la de la población general. Se demostró la importancia del sexo femenino y el drop out de los tratamientos (al margen del tipo de tratamiento en cuestión) como factores de riesgo de sobredosis. La paulatina disminución de muertes por SIDA destaca la importancia de los tratamientos preventivos y terapéuticos adecuados contra la infección de VHC. Las medidas que se adopten en el campo de las drogodependencias, tanto en el ámbito de la política como en la investigación y la formación, deben tener presente el dramáticamente elevado porcentaje de individuos que mueren por consumo de heroína. Participants: All IDUs who had sought medical care at least once in the PCDUs during the study period.Findings: Of 2708 deaths, overdose was found to be the major cause (37%), followed by AIDS (32.5%) and road accidents (9.4%). The percentage of deaths due to AIDS increased steadily from 2.7% in 1985 to 42.2% in 1996, and then decreased to 16.9% in 1998. Deaths due to overdose remained almost constant. The average age of death per year rose from 26 in the mid eighties to 34 in 1998. The mortality rate among IDUs proved much higher compared to the general population of the same age (13-fold, 95% CI 11.3-14.6). The proportion of all deaths attributable to regular use of illegal opiates in the 15-34 age group in the general population in 1991 was 16%. HIV prevalence was not a significant factor in suicides and deaths by overdose.Conclusions: The mortality rate was 13 times greater than in the general population. To be female and...

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Mortality among Drug Users in the AIDS Era

Cited by 26 publications

References 0 publications

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Causes of death among women with human immunodeficiency virus infection in the era of combination antiretroviral therapy

Mortality among people who inject drugs: a systematic review and meta-analysis

Causas principales de muerte entre 2.708 heroinómanos del noreste italiano (1985-1998)

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