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Mortality among drug users in the AIDS era
J J Goedert1, G Pizza, F M Gritti
1AIDS and Cancer Section, Viral Epidemiology Branch, National Cancer Institute, Rockville, MD 20852, USA.
International Journal of Epidemiology
|December 1, 1995
Summary
Human immunodeficiency virus type 1 (HIV-1) infection significantly increases mortality in drug users, not just from AIDS but also from competing causes like hepatic disease. Understanding these diverse mortality factors is crucial for improving patient outcomes.
Area of Science:
- Epidemiology
- Public Health
- Infectious Diseases
Background:
- Human immunodeficiency virus type 1 (HIV-1) infection leads to acquired immunodeficiency syndrome (AIDS) and death.
- Mortality patterns, especially non-AIDS causes, require further investigation in HIV-1 positive individuals.
- A retrospective cohort study was conducted among Italian drug users to assess mortality rates associated with HIV-1 infection.
Purpose of the Study:
- To estimate absolute and proportional mortality rates due to AIDS and other causes in drug users.
- To compare mortality rates between HIV-1 positive, negative, and untested individuals.
- To identify specific causes of death contributing to increased mortality in HIV-1 positive drug users.
Main Methods:
- A cohort of drug users in Bologna, Italy, enrolled between 1980 and 1990 was analyzed.
- Subjects were categorized by HIV-1 antibody status (positive, negative, untested) and vital status.
- Mortality data were collected via national surveillance and death certificates; analysis used actuarial and time-dependent covariate methods.
Main Results:
- A total of 332 deaths occurred among 4962 drug users over 21,130 person-years, an 18-fold increase compared to the general population.
- Ten-year mortality estimates were 28.2% for HIV-1 positive, 12.1% for untested, and 2.5% for HIV-1 negative subjects.
- AIDS was the leading cause of death (150 deaths), followed by drug overdose (64) and trauma (39); HIV-1 positive individuals showed increased mortality from AIDS, trauma, overdose, infections, hepatitis, and cirrhosis.
Conclusions:
- HIV-1 infection is associated with increased mortality from opportunistic infections, malignancies, and competing causes, notably hepatic disease.
- Further research is necessary to determine the role of alcohol, analgesics, and hepatitis viruses in enhanced hepatotoxicity among HIV-1 infected patients.
- These findings highlight the complex mortality landscape in HIV-1 positive individuals, extending beyond AIDS-defining illnesses.