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Causes of mortality among injection drug users enrolled in an antiretroviral program in Vancouver, Canada
A. Sadr1, P.A. Gross1, C. Lai2, D. Littlejohn3, D. Tu2, M.W. Tyndall2
1University of British Columbia, Department of Family Medicine, Vancouver, Canada, 2University of British Columbia, BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 3Vancouver Native Health Society, Vancouver, Canada
Background: The overall impact of highly active antiretroviral therapy (HAART) on reducing HIV-related mortality has been less successful among injection drug users (IDU). We examined the rates and causes of mortality in a cohort of IDUs enrolled in an HIV treatment program.
Methods: Between January 1998 and June 2007, 204 HIV-infected IDUs were started on HAART (1,032 person years). In order to measure mortality rates, date and cause of death were collected from medical records and verified through the provincial Vital Statistics Agency.
Results: Mean age at enrolment was 40.8 years, 150 (74%) were males, 107 (52%) were Aboriginal, and all were current or previous injection drug users. There were 65 deaths for a cumulative mortality of 34.6% (annual mortality rate of 5.3%). Mean age at time of death was 42.5 years (44.1 yrs for males, 37.9 yrs for females). The cause of death was HIV-related in 36 (55%) cases, including AIDS without a specific pathological diagnosis (17); community-acquired pneumonia (5), tuberculosis (3), cryptococcal meningitis (2), mycobacterium avium-complex (2), lymphoma (2), PCP pneumonia (2), PML (2), and Kaposi’s Sarcoma (1). The 29 (45%) deaths not directly HIV-related included end-stage liver disease (9), drug overdose (6), cardiovascular disease (6), stroke (2), suicide (2), chronic lung disease (1), endocarditis (1), cancer (1), and undetermined (1). At the time of death, the mean CD4 count was 198 cells/mm3 and 23% had a plasma viral load less than 50 copies/ml.
Conclusions: Despite the initiation of HIV treatment, mortality rates among this clinic population remain extremely high. In addition to a wide range of HIV related opportunistic infections, non-HIV related events accounted for nearly half of the deaths. Renewed efforts are needed to engage drug users in HIV care and address the social, environmental and addiction-related factors that contribute to these preventable and pre-mature deaths.
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