The shifting pattern of cause‐specific mortality in a cohort of human immunodeficiency virus‐infected and non‐infected injecting drug users

Ferreros, Inmaculada; Lumbreras, Blanca; Hurtado, Isabel; Pérez-Hoyos, Santiago; Hernández-Aguado, Ildefonso

doi:10.1111/j.1360-0443.2008.02135.x

Cited by 27 publications

(24 citation statements)

References 40 publications

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“…We confirm the findings of earlier studies which emphasize that successful ART is possible among former or current IDUs, and particularly effective in the setting of stable opiate substitution [5,11,18,31,32,[46][47][48]. As a consequence, ART should not be withheld from this patient group.…”

Section: Discussionsupporting

confidence: 89%

“…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%

“…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%

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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: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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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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“…[15][16][17] Most of the causes of death associated with the greatest excess mortality, including infection, "other" causes and mental or behavioural disorders, were consistent with major causes of death identified in other studies. 14,15,[18][19][20][21][22][23] Of note was the elevated excess mortality related to respiratory disease (primarily pneumonia). A study involving drug users entering treatment in Rome, Italy, reported a similar SMR of 10.2 for respiratoryrelated death.…”

Section: Discussionmentioning

confidence: 99%

Mortality in a large community-based cohort of inner-city residents in Vancouver, Canada

et al. 2013

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Background:The Downtown Eastside is a robust and densely populated neighbourhood in Vancouver, Canada, that is characterized by low-income housing and drug use and a high prevalence of HIV infection. We evaluated mortality and excess mortality among the broader community of individuals living in this neighbourhood. Compared with the population of Vancouver, significant excess mortality was observed in the study population (SMR 7.1, 95% CI 6.4-7.9). Excess mortality was higher among women (SMR 15.4, 95% CI 12.8-18.5) than among men (SMR 5.8, 95% CI 5.1-6.6). Although crude mortality increased with age, excess mortality was greatest among participants less than 35 years old (SMR 13.2, 95% CI 9.4-18.5) and those 35-39 years old (SMR 13.3, 95% CI 10.3-17.1). Excess risk was also elevated among participants with hepatitis C virus (HCV), HIV and HCV/HIV infection, with SMRs of 5.9 (95% CI 4.9-7.1), 19.2 (95% CI 12.8-28.9) and 23.0 (95% CI 19.3-27.4), respectively. Methods Interpretation:Our study showed high mortality in this inner-city population, particularly when compared with the general population of Vancouver. Excess mortality was highest among women, younger participants and those infected with either HCV or HIV or both. AbstractCMAJ OPEN, 1(2) E69Research

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“…In injecting drug users, the prevalence of HIV is low (<1% in heterosexuals), whereas the prevalence of hepatitis C is high (50–60%) 7. However, one of the consequences of the increased longevity of opioid-dependent people is the attendant risk of age-related health conditions, including cancer 8. The OST agents themselves are not considered risk factors for cancer as murine studies indicate they are not carcinogenic 9 10…”

Section: Introductionmentioning

confidence: 99%

The importance of blood-borne viruses in elevated cancer risk among opioid-dependent people: a population-based cohort study

et al. 2012

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ObjectiveTo quantify cancer risk in opioid dependence and the association with infection by the oncogenic blood-borne viruses (BBVs) hepatitis C (HCV), hepatitis B (HBV) and HIV.DesignCohort study.SettingNew South Wales, Australia.ParticipantsAll 45 412 adults aged 16 years or over registered for opioid substitution therapy (OST) between 1985 and 2007. Notifications of cancer, death and infection with HCV, HBV and HIV were ascertained by record linkage with registries.Main outcome measuresThe ratios of observed to expected number of cancers, standardised incidence ratios (SIRs), and the average annual per cent change (AAPC) in overall age and sex-standardised cancer incidence.ResultsOverall cancer risk was modestly increased compared to the general population (SIR 1.15, 95% CI 1.07 to 1.23). Excess risk was observed for 11 cancers, particularly lung (4.02, 95% CI 3.32 to 4.82), non-Hodgkin's lymphoma (1.51, 95% CI 1.20 to 1.88) and liver (8.04, 95% CI 6.18 to 10.3). Reduced risk was observed for six cancers, including prostate (0.16, 95% CI 0.06 to 0.32) and breast (0.48, 95% CI 0.35 to 0.62). Individuals notified with HCV or HBV had a markedly increased risk of liver cancer; lung cancer risk was also increased in those with HCV. HIV was associated with an elevated risk of liver, anus and kidney cancer, non-Hodgkin lymphoma and Kaposi sarcoma. Cancer risk was not increased in individuals without a BBV notification, apart from pancreatic cancer (3.92, 95% CI 1.07 to 10.0). Cancer incidence increased significantly over time (AAPC 9.4%, 4.2% to 15%, p=0.001).ConclusionsBBVs play a major role in the cancer risk profile of opioid-dependent individuals registered for OST. To address the dramatic increasing trend in cancer incidence, the OST setting could be utilised for cancer prevention strategies.

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The shifting pattern of cause‐specific mortality in a cohort of human immunodeficiency virus‐infected and non‐infected injecting drug users

Abstract: Cardiovascular and cancer mortality are increasing among IDUs, but the increases are not related to HIV infection. We have not found a link between highly active antiretroviral therapy (HAART) introduction and increases in mortality for specific causes.

Cited by 27 publications

References 40 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

Mortality in a large community-based cohort of inner-city residents in Vancouver, Canada

The importance of blood-borne viruses in elevated cancer risk among opioid-dependent people: a population-based cohort study

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