The relationship between non-injection drug use behaviors on progression to AIDS and death in a cohort of HIV seropositive women in the era of highly active antiretroviral therapy use

Farzana Kapadia, Judith A. Cook, Marge H. Cohen, Nancy Sohler, Andrea Kovacs, Ruth M. Greenblatt, Imtiaz Choudhary, David Vlahov

Research output: Contribution to journalArticle

Abstract

Aims: To evaluate the effects of longitudinal patterns and types of non-injection drug use (NIDU) on HIV progression in the highly active antiretroviral therapy (HAART) era. Design: Women's Interagency HIV Study (WIHS), a prospective cohort study conducted at six US sites. Methods: Data were collected semi-annually from 1994 to 2002 on 1046 HIV+ women. Multivariate Cox proportional hazards modeling was used to estimate relative hazards for developing AIDS and for death by pattern and type of NIDU. Findings: During follow-up, 285 AIDS events and 287 deaths, of which 177 were AIDS-related, were reported. At baseline, consistent and former NIDU was associated with CD4+ counts of < 200 cells/μl (43% and 46%, respectively) and viral load > 40 000 copies/ml (53% and 55%, respectively). Consistent NIDU reported less HAART use (53%) compared with other NIDU patterns. Stimulant use was associated with CD4+ cell counts of < 200 cells/μl (53%) and lower HAART initiation (63%) compared with other NIDU types. In multivariate analyses, progression to AIDS was significantly higher among consistent (RH = 2.52), inconsistent (RH = 1.63) and former (RH = 1.56) users compared with never users; and for stimulant (RH = 2.04) and polydrug (RH = 1.65) users compared with non-users. Progression to all-cause death was higher only among former users (RH = 1.48) compared with never users in multivariate analysis. NIDU behaviors were not associated with progression to AIDS-related death. Conclusions: In this study, pattern and type of NIDU were associated with HIV progression to AIDS and all-cause mortality. These differences were associated with lower HAART utilization among consistent NIDU and use of stimulants, and poor baseline immunological and virological status among former users.

Original languageEnglish (US)
Pages (from-to)990-1002
Number of pages13
JournalAddiction
Volume100
Issue number7
DOIs
StatePublished - Jul 2005

Keywords

  • Acquired immunodeficiency syndrome
  • Highly active antiretroviral therapy
  • Human immunodeficiency virus
  • Mortality
  • Non-injection drug use

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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