HIV treatment outcomes among people who inject drugs in Victoria, Australia.

Nick Walsh,Handan Wand,Nick Crofts,Kerrie Watson,John Mcneil,Christopher K Fairley,Lisa Maher,Anne Mijch

doi:10.1186/s12879-014-0707-9

Abstract

BackgroundPeople who inject drugs (PWID) are a key population affected by HIV. We assessed the effectiveness of HIV treatment among a clinical cohort of people living with HIV (PLHIV) diagnosed and referred for community-based antiretroviral therapy (ART) in Victoria, Australia.MethodsHIV notification data from a central statewide registry were matched with HIV clinical data from two large HIV treatment centers in Melbourne. We used survival analysis and Cox proportional hazard models to estimate time to AIDS and death for PWID in HIV treatment, compared with non-injectors, in the period 1996 – 2008.ResultsOf the 871 individuals, 93 (10.8%) had injecting as an exposure category and 671 (86%) had ever commenced ART. Adjusted analysis showed younger age, high initial CD4 cell count (>500 cells/mm3) or ever having a CD4 cell count >500/mm3, and more recent calendar year of ART commencement were all associated with reduced hazards for AIDS and death, while older age, low initial CD4 cell count (<200/mm3), ever having a CD4 count <200/mm3 (before or during treatment) and high initial viral load (>5 log10) were associated with increased risk of AIDS and death. PWID were no more likely to experience AIDS (HR 0.98[0.54 – 1.80]) or death (HR 0.78 [0.18 – 3.42]) than non-injectors.ConclusionSurvival of HIV-infected PWID on HIV treatment was equivalent to non-injectors. CD4 cell count, initial viral load, calendar year of commencing ART and age are more important determinants of AIDS and mortality than injecting status for in-treatment PLHIV in Victoria, Australia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0707-9) contains supplementary material, which is available to authorized users.

Highlights

People who inject drugs (PWID) are a key population affected by HIV
There were 918 individuals included in the final analysis, of which 871 had a recorded exposure category for HIV acquisition, including 628 (79.4%) men who have sex with men (MSM) and 93 (10.8%) PWID
PWID were significantly younger than non-injectors, while the gender distribution was consistent between the groups

Summary

Introduction

People who inject drugs (PWID) are a key population affected by HIV. We assessed the effectiveness of HIV treatment among a clinical cohort of people living with HIV (PLHIV) diagnosed and referred for community-based antiretroviral therapy (ART) in Victoria, Australia. People who inject drugs (PWID) are a key population affected by HIV [1]. In Australia the prevalence of HIV among PWID has remained steady at around 1 – 2% since the mid 1980s [2]. 3% of HIV diagnoses in Australia are attributed solely to injecting drug use; this proportion has remained steady since the early 1990s [3,4]. While the proportion of diagnoses attributable only to injecting drug use remains low, individuals are often in more than one risk population for HIV acquisition, such as men who have sex with men (MSM) and PWID.

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Results

Discussion

Conclusion