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

Margaret T. May, Amy C. Justice, Kate Birnie, Suzanne M. Ingle, Colette Smit, Colette Smith, Didier Neau, Marguerite Guiguet, Carolynne Schwarze-Zander, Santiago Moreno, Jodie L. Guest, Antonella D.Arminio Monforte, Cristina Tural, Michael J. Gill, Andrea Bregenzer, Ole Kirk, Michael Saag, Timothy R. Sterling, Heidi M. Crane, Jonathan A.C. Sterne

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Abstract

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. 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 HCV2 (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.
Original languageEnglish
Pages (from-to)348-354
JournalJournal of Acquired Immune Deficiency Syndromes
Volume69
Issue number3
DOIs
Publication statusPublished - 1 Jan 2015

Keywords

  • antiretroviral therapy
  • cohort study
  • hepatitis C virus
  • HIV-1
  • injection drug use
  • mortality

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    May, M. T., Justice, A. C., Birnie, K., Ingle, S. M., Smit, C., Smith, C., Neau, D., Guiguet, M., Schwarze-Zander, C., Moreno, S., Guest, J. L., Monforte, A. D. A., Tural, C., Gill, M. J., Bregenzer, A., Kirk, O., Saag, M., Sterling, T. R., Crane, H. M., & Sterne, J. A. C. (2015). Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration. Journal of Acquired Immune Deficiency Syndromes, 69(3), 348-354. https://doi.org/10.1097/QAI.0000000000000603