High mortality among HIV-infected injecting drug users without AIDS diagnosis: implications for HIV infection epidemic modellers?

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Abstract

Objective.

To quantify mortality without AIDS diagnosis (pre-AIDS death) among HIV-infected injecting drug users (IDU) and to compare it with that among homosexual men.

Setting.

Municipal Health Service in Amsterdam, The Netherlands.

Design.

HIV-infected participants of a cohort of homosexual men (recruited since 1984) and a cohort of IDU (recruited since 1985) were followed up to investigate the occurrence of AIDS and pre-AIDS death up to 1 October 1992. Both seroprevalent and seroconverted participants were included.

Methods.

Product-limit estimates of cumulative AIDS incidence and cumulative pre-AIDS mortality were calculated for a competing risks model.

Results.

Of 455 HIV-infected homosexual men, 127 developed AIDS and two died without a diagnosis of AIDS during follow-up; 31 out of 279 HIV-infected IDU were diagnosed with AIDS and 33 died without an AIDS diagnosis. After 6.5 years of follow-up an estimated 43.7% of the homosexual men had been diagnosed with AIDS and 0.7% had died without an AIDS diagnosis, while 32.7% of the IDU had been diagnosed with AIDS and 19.8% had died without an AIDS diagnosis.

Conclusions.

After 6.5 years of follow-up one-fifth of a group of HIV-infected IDU had died without being diagnosed with AIDS. This phenomenon seriously limits the number of HIV-infected IDU that may ever be diagnosed with AIDS and should be-considered by HIV—infection epidemic modellers. The new case definitions for AIDS will limit the number of recorded cases of pre-AIDS death.

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