An article published in a special HIV/AIDS issue of JAMA on August 6 reports that there is little difference in the survival rates between injection drug users (IDUs) and non-injection drug users (non-IDUs) who receive highly active antiretroviral therapy (HAART) for four to five years. This research, conducted by Julio S. G. Montaner, M.D., F.R.C.P.C., (University of British Columbia and St. Paul’s Hospital, Vancouver, Canada, and President-Elect, International AIDS Society), is contrary to the current popular belief that IDUs receive less benefit from the therapy than non-IDUs.
Although HIV-infected persons receiving HAART have shown considerable reductions in illness and HIV-related death since the mid-1990, “A large number of prior reports have demonstrated that because of issues of social instability related to illicit drug addiction, HIV-infected IDUs may not be deriving the full benefits of HAART,” write the authors. In addition, there are reports that show how IDUs are not as likely to be prescribed HAART and how injection drug use was associated with worse HAART outcomes. Long-term evaluations, however, that compare HIV-treatment outcomes among IDUs and other risk groups have not been conducted.
In this study, Dr. Montaner and colleagues analyzed the death rate of 3,116 patients at an HIV/AIDS treatment program in British Columbia, Canada. Of the total participants, 29.4% were IDUs (915 of 3,116). All patients received HAART treatment that began between August 1996 and June 2006. On average, IDU patients were followed-up for 5.3 years and non-IDU patients for 4.3 years until June 30, 2007.
Twenty percent of the patients died during the study period, 232 IDUs and 390 non-IDUs. The researchers found no statistical difference between the cumulative all-cause mortality rate of the 915 IDUs (26.5%) and the 2,201 non-IDUs (21.6%) through seven years after initiating HAART. Statistically controlling for age, sex, baseline AIDS diagnosis, baseline CD4 cell count, adherence, and physician experience did not alter the researchers’ conclusions.
The authors conclude: “Although our findings cannot be generalized outside of [this] cohort, as efforts to improve use of HAART among IDUs expand, the fact that survival patterns were not significantly different between IDUs and non-IDUs should help to challenge the increasingly prevalent belief that IDUs may be markedly less likely to benefit from HAART. Based on these results, we conclude that HAART regimens may have effectiveness at a populational level that is not significantly different regarding the survival of individuals with and without a history of injection drug use.”
Highly Active Antiretroviral Therapy and Survival in HIV-Infected Injection Drug Users
Evan Wood; Robert S. Hogg; Viviane Dias Lima; Thomas Kerr; Benita Yip; Brandon D. L. Marshall; Julio S. G. Montaner
JAMA(2008). 300[5]: pp. 550 -554.
Written by: Peter M Crosta