Influence of noninjecting and injecting drug use on mortality, retention in the cohort, and antiretroviral therapy, in participants in the Swiss HIV Cohort Study.

Weber, R; Huber, M; Battegay, M; Stähelin, Cornelia Johanna; Castro Batanjer, E; Calmy, A; Bregenzer, A; Bernasconi, E; Schoeni-Affolter, F; Ledergerber, B (2015). Influence of noninjecting and injecting drug use on mortality, retention in the cohort, and antiretroviral therapy, in participants in the Swiss HIV Cohort Study. HIV medicine, 16(3), pp. 137-151. Blackwell Science 10.1111/hiv.12184

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OBJECTIVES

We studied the influence of noninjecting and injecting drug use on mortality, dropout rate, and the course of antiretroviral therapy (ART), in the Swiss HIV Cohort Study (SHCS).

METHODS

Cohort participants, registered prior to April 2007 and with at least one drug use questionnaire completed until May 2013, were categorized according to their self-reported drug use behaviour. The probabilities of death and dropout were separately analysed using multivariable competing risks proportional hazards regression models with mutual correction for the other endpoint. Furthermore, we describe the influence of drug use on the course of ART.

RESULTS

A total of 6529 participants (including 31% women) were followed during 31 215 person-years; 5.1% participants died; 10.5% were lost to follow-up. Among persons with homosexual or heterosexual HIV transmission, noninjecting drug use was associated with higher all-cause mortality [subhazard rate (SHR) 1.73; 95% confidence interval (CI) 1.07-2.83], compared with no drug use. Also, mortality was increased among former injecting drug users (IDUs) who reported noninjecting drug use (SHR 2.34; 95% CI 1.49-3.69). Noninjecting drug use was associated with higher dropout rates. The mean proportion of time with suppressed viral replication was 82.2% in all participants, irrespective of ART status, and 91.2% in those on ART. Drug use lowered adherence, and increased rates of ART change and ART interruptions. Virological failure on ART was more frequent in participants who reported concomitant drug injections while on opiate substitution, and in current IDUs, but not among noninjecting drug users.

CONCLUSIONS

Noninjecting drug use and injecting drug use are modifiable risks for death, and they lower retention in a cohort and complicate ART.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Stähelin, Cornelia Johanna

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1464-2662

Publisher:

Blackwell Science

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

23 Feb 2016 17:29

Last Modified:

23 Feb 2016 17:29

Publisher DOI:

10.1111/hiv.12184

PubMed ID:

25124393

Uncontrolled Keywords:

HIV infection; alcohol use; antiretroviral therapy; cohort study; injecting drug use; noninjecting drug use; opiate substitution; smoking

BORIS DOI:

10.7892/boris.75473

URI:

https://boris.unibe.ch/id/eprint/75473

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