The Effects of Opioid Substitution Treatment and Highly Active Antiretroviral Therapy on the Cause-Specific Risk of Mortality among HIV-Positive People Who Inject Drugs

Prior studies indicated opioid substitution treatment (OST) reduces mortality risk and improves the odds of accessing highly active antiretroviral therapy (HAART); however, the relative effects of these treatments for human immunodeficiency virus (HIV)-positive people who inject drugs (PWID) are unclear. We determine the independent and joint effects of OST and HAART on mortality, by cause, within a population of HIV-positive PWID initiating HAART.

Using a linked population-level database for British Columbia, Canada, we used time-to-event analytic methods, including competing risks models, proportional hazards models with time-varying covariates, and marginal structural models, to identify the independent and joint effects of OST and HAART on all-cause as well as drug- and HIV-related mortality, controlling for covariates.

Among 1727 HIV-positive PWID, 493 (28.5%) died during a median 5.1 years of follow-up: 

• 18.7% due to drug-related causes, 
• 55.8% due to HIV-related causes, 
• and 25.6% due to other causes. 

Standardized mortality ratios were 12.2 during OST and 30.0 during periods out of OST. Both OST and HAART decreased the hazard of all-cause mortality; however, individuals were at lowest risk of death when these medications were used jointly. Both OST and HAART independently protected against HIV-related death, drug-related death and death due to other causes.

While both OST and HAART are life-saving treatments, joint administration is urgently needed to protect against both drug- and HIV-related mortality.

Via:  http://ht.ly/SpmkD 

By: Nosyk B1, Min JE2, Evans E3, Li L3, Liu L4, Lima VD5, Wood E5, Montaner JS5.

• 1BC Centre for Excellence in HIV/AIDS, Vancouver Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
• 2BC Centre for Excellence in HIV/AIDS, Vancouver.
• 3University of California-Los Angeles Integrated Substance Abuse Programs.
• 4Department of Preventative Medicine, Northwestern University, Chicago, Illinois.
• 5BC Centre for Excellence in HIV/AIDS, Vancouver Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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