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Mortality declines among people with HIV who inject drugs in Canada

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December 24, 2017

Recent data showed a significant reduction in all-cause mortality over the past 2 decades among people with HIV who inject drugs in Vancouver, British Columbia, Canada.

The decline coincides with a scale-up of communitywide “seek-and-treat” interventions targeting hard-to-treat HIV populations beginning in 2010, according to Kanna Hayashi, PhD, MPH, associate professor at Simon Fraser University and the British Columbia Centre for Excellence in HIV/AIDS at St. Paul’s Hospital, and colleagues.

“High mortality rates among people who inject drugs (PWID) living with HIV [have] been well documented, with drug overdose and HIV/AIDS-associated conditions the leading causes of death, largely as a result of suboptimal access to HIV care,” the researchers wrote in The Journal of Infectious Diseases. “However, there is scant literature examining the impact of recent efforts to expand access to ART.”

The researchers examined trends in all-cause mortality using data from the ACCESS trial, a prospective cohort study of PWID with HIV in Vancouver. Their analysis included 961 participants (36.7% women) who responded to a questionnaire assessing drug use patterns and demographic information during a baseline visit and at least one follow-up visit between May 1996 and May 2014. Data from the British Columbia Vital Statistics Agency were used to analyze mortality and underlying causes of death among participants.

Over the study period, 297 deaths were identified, yielding a crude mortality rate of 4.6 (95% CI, 4.1-5.1) deaths per 100 person-years. HIV and overdoses accounted for 43.4% and 19.2% of deaths, respectively. All-cause mortality declined from 6 (95% CI, 5.1-7. 1) deaths per 100 person-years in 1996 to 2003 to 5.3 (95% CI, 4.4-6.4) deaths per 100 person-years in 2004 to 2009 and 3 (95% CI, 2.4-3.9) deaths per 100 person-years in 2010 to 2014. A longer duration of injection drug use independently predicted mortality among women (adjusted HR = 1.03; 95% CI, 1.01-1.05) and daily prescription opioid use predicted mortality among men (aHR = 1.93; 95% CI, 1.24-3).

After the scale-up in “seek-and-treat” interventions in 2010, the researchers observed a significant decrease in all-cause and HIV-related mortality rates among men and women, as well as overdose mortality rates among men (all P < .05). All-cause mortality was 42% less likely to occur among men receiving ART (aHR = 0.58; 95% CI, 0.39-0.88) and 45% less likely to occur among women receiving ART (aHR = 0.55; 95% CI, 0.33-0.91) compared with participants not receiving ART. However, this benefit was not observed among ART users whose virus was not suppressed, according to the researchers.

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“Therefore, helping HIV-infected PWID maintain their [viral load] at undetectable levels is an important area to direct future efforts to further reduce mortality,” they concluded.

Disclosures: Hayashi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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