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

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author May Margaret T., Justice Amy C., Birnie Kate, Ingle Suzanne M., Smit Colette, Smith Colette, Neau Didier, Guiguet Marguerite, Schwarze-Zander Carolynne, Moreno Santiago, Guest Jodie L., Monforte Antonella dArminio, Tural Cristina, Gill Michael J., Bregenzer Andrea, Kirk Ole, Saag Michael, Sterling Timothy R., Crane Heidi M., Sterne Jonathan A. C.,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal JAIDS Journal of Acquired Immune Deficiency Syndromes
Volume (Issue) 69(3)
Page(s) 348 - 354
Title of proceedings JAIDS Journal of Acquired Immune Deficiency Syndromes
DOI 10.1097/qai.0000000000000603

Open Access

URL https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25848927/
Type of Open Access Repository (Green Open Access)

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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