Do HIV Disease Progression and HAART Response Vary among Injecting Drug Users in Europe?

• Published in: European journal of epidemiology Vol. 20; no. 9; pp. 795 - 804
• Main Authors: van Asten, Liselotte, Zangerle, Robert, Aguado, Ildefonso Hernández, Boufassa, Faroudy, Broers, Barbara, Brettle, Raymond P., Robertson, J. Roy, McMenamin, Jim, Coutinho, Roel A., Prins, Maria
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer 01-09-2005; Springer Nature B.V
• Subjects: Adult; AIDS; Antiretroviral Therapy, Highly Active; Antivirals; Biological and medical sciences; Cause of Death; Causes of death; CD4 Lymphocyte Count; Death; Disease Progression; Drug therapy; Drug use; Epidemiology; Europe - epidemiology; Female; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - mortality; Homicide; Human immunodeficiency virus; Human viral diseases; Humans; Immune response; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious Diseases; Male; Medical sciences; Miscellaneous; Mortality; Overdose; Proportional Hazards Models; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Risk Factors; Substance Abuse, Intravenous - mortality; Suicide; Survival Analysis; T lymphocytes; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Europe; Switzerland, Geneva; Netherlands, Noord-Holland, Amsterdam; France, Paris; British Isles, Scotland, Glasgow; Spain; British Isles, Scotland, Edinburgh; Human; Immunopathology; Drug addiction; HIV disease progression; Prognosis; Treatment efficiency; Europe; AIDS; Immune deficiency; Epidemiology; Infection; Chemotherapy; Treatment; Highly Active Antiretroviral Therapy; Viral disease; Interindividual comparison; Antiviral; Evolution; Public health; Injecting drug users
• ISSN: 0393-2990; 1573-7284
• DOI: 10.1007/s10654-005-1049-0

Prior to HAART availability, there was no evidence of a geographical variation in HIV disease progression among injecting drug users (IDU) from different European regions. Nowadays, factors of importance regarding HIV disease progression in the face of HAART availability, such as HAART access, adherence, and the organization of care for IDU may differ across Europe. Therefore we studied HIV disease progression in a European study of IDU with known dates of HIV-seroconversion. Results show that with ongoing HAART availability, the risk of HIV disease progression has continued to decrease. When accounting for pre-AIDS death (in AIDS analyses) and non-natural deaths (suicide, overdose, accidents and homicide, in analyses of death) which are common among IDU, the risk of AIDS and death has decreased by as much as 65% and 75%, respectively, in 2000/2001. Results show little geographic variation in progression to AIDS. All-cause mortality was higher in IDU from Glasgow than elsewhere, while in the Valencian region (Spain) IDU were at a significantly lower risk of non-natural deaths. The timing of HAART initiation by treatment-naïve IDU likewise differed across Europe: IDU in Amsterdam, Innsbruck, and Edinburgh started at significantly lower CD4 counts than IDU in Paris, Geneva, Glasgow, and the Valencian region, but the subsequent short-term immune response was similar. In conclusion, the risk in progression to AIDS or natural death is similar across western Europe although IDU across Europe differ in other factors, such as the risk of non-natural death and the timing of HAART initiation.