Titre : | Highly active antiretroviral therapy and survival in HIV-infected injection drug users (2008) |
Auteurs : | E. WOOD ; R. S. HOGG ; V. D. LIMA ; T. KERR ; B. YIP ; B. D. L. MARSHALL ; J. S. G. MONTANER |
Type de document : | Article : Périodique |
Dans : | Journal of the American Medical Association (Vol.300, n°5, August 6, 2008) |
Article en page(s) : | 550-554 |
Langues: | Anglais |
Discipline : | MAL (Maladies infectieuses / Infectious diseases) |
Mots-clés : |
Thésaurus mots-clés VIH ; ANTIRETROVIRAUX ; INJECTION ; USAGER ; TRAITEMENT ; MORTALITEThésaurus géographique CANADA |
Résumé : | CONTEXT: Highly active antiretroviral therapy (HAART) is often withheld from injection drug users (IDUs) infected with the human immunodeficiency virus (HIV) based on the belief that their unstable lifestyles may predetermine a markedly inferior outcome with HAART. However, long-term evaluations of HIV treatment outcomes among IDUs in comparison with other risk groups are not available. OBJECTIVE: To compare survival rates among HIV-infected patients initiating HAART with and without a history of injection drug use. DESIGN, SETTING, AND PATIENTS: Population-based, prospective cohort study (HAART Observational Medical Evaluation and Research [HOMER]) of 3116 antiretroviral-naive HIV-infected patients in a province-wide HIV/AIDS treatment program in British Columbia, Canada. Of the 3116 patients, 915 were IDUs (29.4%), 579 were female (18.6%), and the median age was 39.4 years (interquartile range, 33.3-46.4 years). Treatment with HAART was initiated between August 1, 1996, and June 30, 2006. The median duration of follow-up was 5.3 years (interquartile range, 2.8-8.3 years) for IDUs and 4.3 years (interquartile range, 2.0-7.6 years) for non-IDUs. Patients were followed up until June 30, 2007. Data were analyzed between November 1, 2007, and May 26, 2008. MAIN OUTCOME MEASURE: All-cause mortality. RESULTS: Overall, 622 individuals died (20.0%) during the study period (232 IDUs and 390 non-IDUs), for a crude mortality rate of 20.0% (95% confidence interval [CI], 18.4%-21.5%). At 84 months after the initiation of HAART, the product limit estimate of the cumulative all-cause mortality rate was similar between the 915 IDUs (26.5%; 95% CI, 23.2%-29.8%) and 2201 non-IDUs (21.6%; 95% CI, 16.9%-26.2%) (Wilcoxon P = .47). In multivariate time-updated Cox regression, the hazard ratio of mortality was similar between IDUs and non-IDUs (1.09; 95% CI, 0.92-1.29). CONCLUSION: In this study population, injection drug use was not associated with decreased survival among HIV-infected patients initiating HAART. |
Domaine : | Drogues illicites / Illicit drugs |
Refs biblio. : | 27 |
Affiliation : | British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada |
Centre Emetteur : | 13 OFDT |
Lien : | http://dx.doi.org/10.1001/jama.300.5.550 |
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