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. 2015 Jul 1;69(3):348-54.
doi: 10.1097/QAI.0000000000000603.

Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration

Margaret T May  1 , Amy C Justice, Kate Birnie, Suzanne M Ingle, Colette Smit, Colette Smith, Didier Neau, Marguerite Guiguet, Carolynne Schwarze-Zander, Santiago Moreno, Jodie L Guest, Antonella dʼArminio Monforte, Cristina Tural, Michael J Gill, Andrea Bregenzer, Ole Kirk, Michael Saag, Timothy R Sterling, Heidi M Crane, Jonathan A C Sterne
Affiliations

Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration

Margaret T May et al. J Acquir Immune Defic Syndr. .

Abstract

Background: HIV-infected individuals with a history of transmission through injection drug use (IDU) have poorer survival than other risk groups. The extent to which higher rates of hepatitis C (HCV) infection in IDU explain survival differences is unclear.

Methods: Adults who started antiretroviral therapy between 2000 and 2009 in 16 European and North American cohorts with >70% complete data on HCV status were followed for 3 years. We estimated unadjusted and adjusted (for age, sex, baseline CD4 count and HIV-1 RNA, AIDS diagnosis before antiretroviral therapy, and stratified by cohort) mortality hazard ratios for IDU (versus non-IDU) and for HCV-infected (versus HCV uninfected).

Results: Of 32,703 patients, 3374 (10%) were IDU; 4630 (14%) were HCV+; 1116 (3.4%) died. Mortality was higher in IDU compared with non-IDU [adjusted HR 2.71; 95% confidence interval (CI): 2.32 to 3.16] and in HCV+ compared with HCV- (adjusted HR 2.65; 95% CI: 2.31 to 3.04). The effect of IDU was substantially attenuated (adjusted HR 1.57; 95% CI: 1.27 to 1.94) after adjustment for HCV, while attenuation of the effect of HCV was less substantial (adjusted HR 2.04; 95% CI: 1.68 to 2.47) after adjustment for IDU. Both IDU and HCV were strongly associated with liver-related mortality (adjusted HR 10.89; 95% CI: 6.47 to 18.3 for IDU and adjusted HR 14.0; 95% CI: 8.05 to 24.5 for HCV) with greater attenuation of the effect of IDU (adjusted HR 2.43; 95% CI: 1.24 to 4.78) than for HCV (adjusted HR 7.97; 95% CI: 3.83 to 16.6). Rates of CNS, respiratory and violent deaths remained elevated in IDU after adjustment for HCV.

Conclusions: A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.

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Figures

Figure 1
Figure 1
Kaplan-Meier estimate of survival probability by HCV status and IDU transmission group.
See this image and copyright information in PMC

References

    1. Egger M, May M, Chene G, et al. Prognosis of HIV-1-infected patients starting highly active antiretroviral therapy: a collaborative analysis of prospective studies. Lancet. 2002;360(9327):119–29. - PubMed
    1. Larsen MV, Omland LH, Gerstoft J, et al. Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study. Addiction. 2010;105(3):529–35. - PubMed
    1. Mathers BM, Degenhardt L, Bucello C, et al. Mortality among people who inject drugs: a systematic review and meta-analysis. Bulletin of the World Health Organization. 2013;91(2):102–23. - PMC - PubMed
    1. Gill MJ, May MT, Lewden C, et al. Causes of death in HIV-1 infected patients treated with antiretroviral therapy 1996-2006: collaborative analysis of 13 HIV cohorts. Clin Infect.Dis. 2010;50(10):1387–96. - PMC - PubMed
    1. Green TC, McGowan SK, Yokell MA, et al. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS. 2012;26(4):403–17. - PMC - PubMed

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