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High incidence of mortality in a cohort of HIV positive and negative injection drug users in Chennai, India
S.S. Solomon1, D.D. Celentano2, A.K. Srikrishnan1, C.K. Vasudevan1, S. Anand1, M.S. Kumar3, S. Solomon1, S.H. Mehta2
1YR Gaitonde Centre for AIDS Research and Education, Chennai, India, 2Johns Hopkins University Bloomberg School of Public Health, Baltimore, United States, 3Consultant - YRGCARE, Chennai, India
Background: IDUs have estimated mortality rates which are at least ten times higher than the general population; much of this excess mortality is HIV-associated. Few mortality estimates among IDUs from developing countries, including India, exist. The objectives of this analysis were to characterize mortality risk and causes of death among IDUs in Chennai, India.
Methods: A cohort of 1158 IDUs was recruited in Chennai between April 2005 and May 2006. 293 (25%) were HIV positive. Information on deaths and associated causes were obtained through outreach workers and death reports from family members. Multivariate Poisson regression was used to analyze associations of baseline covariates and all- cause mortality over the first two years.
Results: We observed 70 deaths over 2168 person-years (PY) of follow-up (Incidence Rate [IR]: 3.2; 95%CI: 2.5 - 4.1). The risk of mortality among HIV positive IDUs (IR: 5.7 per 100 PY) was more than twice that of negative IDUs (IR: 2.3 per 100 PY). This association persisted after adjustment for age, hepatitis C virus status, injection frequency, types of drugs injected, alcohol use, and incarceration. The leading causes of mortality in both HIV negative and positive IDUs were overdose (n=19), tuberculosis (n=12) and accident/trauma-related (n=9). Death rates from overdose and tuberculosis were higher in HIV positive than negative IDUs, though not statistically significant. Only 4 deaths in HIV positive IDUs were identified as being AIDS-related (IR: 0.7 per 100 PY).
Conclusions: The overall mortality rate in this cohort of IDUs was high. Though in the first two years of follow-up, non-AIDS deaths outnumbered AIDS-associated deaths, it is possible that the relative contribution of AIDS-associated mortality will increase with HIV disease progression and limited access to antiretroviral therapy. These data clearly indicate that prevention and treatment interventions to reduce the harms associated with drug use are urgently needed among IDUs in Chennai.
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