Association of Injection Drug Use with Incidence of HIV-Associated Non-AIDS-Related Morbidity by Age, 1995-2014

OBJECTIVE:

Incidence of HIV-associated non-AIDS (HANA) related comorbidities is increasing in HIV-infected individuals. Our objective was to estimate the risk of HANA comorbidity associated with history of injection drug use (IDU), correctly accounting for higher death rates among people who inject drugs (PWID).

DESIGN:

We followed HIV-infected persons aged 25-59 years who enrolled in the Johns Hopkins HIV Clinical Cohort between 1995 and May 2014, from enrollment until HANA comorbidity diagnosis, death, age 60 or administrative censoring.

METHODS:

We compared cumulative incidence ("risk"), by age, of validated diagnoses of HANA comorbidities among HIV-infected PWID and non-IDU; specifically, we considered end-stage renal disease (ESRD), end-stage liver disease (ESLD), myocardial infarction (MI), stroke, and non-AIDS-defining cancer. We used competing risk methods appropriate to account for death, standardized to the marginal distribution of baseline covariates and adjusted for potential differential loss-to-clinic.

RESULTS:

Of 5,490 patients included in this analysis, 37% reported IDU as an HIV transmission risk. By age 55 years, PWID had higher risk of ESLD (risk difference = 6.8, 95% CI: -1.9, 15.5) and ESRD (risk difference = 11.1, 95% CI: 1.2, 21.0) than did non-IDU. Risk of MI and stroke were similar among PWID and non-IDU. Risk of non-AIDS-defining cancer was lower among PWID than among non-IDU (risk difference at 55 years: -4.9, 95% CI: -11.2, 1.3).

CONCLUSIONS:

Not all HANA comorbidities occur with higher incidence in PWID compared to non-IDU. However, higher incidence of ESRD and ESLD among PWID highlights the importance of recognition and management of markers of these comorbidities in early stages among PWID.

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By:  Lesko CR1, Moore RD, Tong W, Lau B.

• 1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 
• School of Medicine, Johns Hopkins University, Baltimore, MD. 
• AIDS. 2016 Mar 16. 

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