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Evan Wood, MD, PhD; Robert S. Hogg, PhD; Viviane Dias Lima, PhD; Thomas Kerr, PhD; Benita Yip, BSc (Pharm); Brandon D. L. Marshall, MSc; Julio S. G. Montaner, MD, FRCPC

JAMA. 2008;300(5):550-554.

Context  Highly active antiretroviral therapy (HAART) is often withheld from injection drug users (IDUs) infected with the human immunodeficiency virus (HIV) based on the belief that their unstable lifestyles may predetermine a markedly inferior outcome with HAART. However, long-term evaluations of HIV treatment outcomes among IDUs in comparison with other risk groups are not available.

Objective  To compare survival rates among HIV-infected patients initiating HAART with and without a history of injection drug use.

Design, Setting, and Patients  Population-based, prospective cohort study (HAART Observational Medical Evaluation and Research [HOMER]) of 3116 antiretroviral-naive HIV-infected patients in a province-wide HIV/AIDS treatment program in British Columbia, Canada. Of the 3116 patients, 915 were IDUs (29.4%), 579 were female (18.6%), and the median age was 39.4 years (interquartile range, 33.3-46.4 years). Treatment with HAART was initiated between August 1, 1996, and June 30, 2006. The median duration of follow-up was 5.3 years (interquartile range, 2.8-8.3 years) for IDUs and 4.3 years (interquartile range, 2.0-7.6 years) for non-IDUs. Patients were followed up until June 30, 2007. Data were analyzed between November 1, 2007, and May 26, 2008.

Main Outcome Measure  All-cause mortality.

Results  Overall, 622 individuals died (20.0%) during the study period (232 IDUs and 390 non-IDUs), for a crude mortality rate of 20.0% (95% confidence interval [CI], 18.4%-21.5%). At 84 months after the initiation of HAART, the product limit estimate of the cumulative all-cause mortality rate was similar between the 915 IDUs (26.5%; 95% CI, 23.2%-29.8%) and 2201 non-IDUs (21.6%; 95% CI, 16.9%-26.2%) (Wilcoxon P = .47). In multivariate time-updated Cox regression, the hazard ratio of mortality was similar between IDUs and non-IDUs (1.09; 95% CI, 0.92-1.29).

Conclusion  In this study population, injection drug use was not associated with decreased survival among HIV-infected patients initiating HAART.

Author Affiliations: British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver; Faculty of Medicine, University of British Columbia, Vancouver (Drs Wood, Lima, Kerr, and Montaner); and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia (Dr Hogg).

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