Highly active antiretroviral therapy and survival in HIV-Infected injection drug users

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.