A comparison of exposure groups in the EuroSIDA study: starting highly active antiretroviral therapy (HAART), response to HAART, and survival. NLM AIDSLINE Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.

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A comparison of exposure groups in the EuroSIDA study: starting highly active antiretroviral therapy (HAART), response to HAART, and survival.

J Acquir Immune Defic Syndr. 1999 Dec 1;22(4):369-78. Unique Identifier : AIDSLINE MED/20097665
Mocroft A; Madge S; Johnson AM; Lazzarin A; Clumeck N; Goebel FD; Viard JP; Gatell J; Blaxhult A; Lundgren JD; Royal Free Centre for HIV Medicine, Royal Free and University; College Medical School, London, England. amanda@rfhsm.ac.uk

Abstract: BACKGROUND: Concerns have been raised that intravenous drug users may be less likely to start highly active antiretroviral therapy (HAART) and that adherence to therapy may be poor among this group of patients. Given the decreased mortality and incidence of AIDS-defining illnesses among patients with HIV who start HAART, this may lead to a poorer prognosis among intravenous drug users. PURPOSE: To compare homosexual men, intravenous drug users, and heterosexuals in EuroSIDA, a prospective European cohort of 7331 patients with HIV in terms of starting a HAART treatment regimen, immunologic and virologic response to therapy, and survival. METHODS: 6645 patients were included in this analysis. Logistic regression and Cox proportional hazards models were used to investigate the factors associated with use of HAART regimens and survival following recruitment to the EuroSIDA study. RESULTS: In a multivariate logistic regression model, intravenous drug users were significantly less likely to be receiving HAART at recruitment to EuroSIDA (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.37-0.62; p<.0001) when compared with homosexual men. Similarly, during follow-up, intravenous drug users were at a 27% reduced risk of starting HAART, after adjustment for other factors related to starting HAART (relative hazard [RH], 0.73; 95% CI, 0.64-0.82; p<.0001). There were no differences between heterosexual and homosexual patients, and similar results were found within regions of Europe (South, Central and Northern). Among those patients who started HAART, there were no significant differences between exposure groups in CD4 lymphocyte count response to HAART or virologic response to HAART. After adjustment for factors related to survival, intravenous drug users were at a small, but nonsignificant increased risk of death compared with homosexuals (RH 1.16; 95% CI, 0.99-1.38; p = .074). CONCLUSIONS: Intravenous drug users were significantly less likely to start HAART, but among those who did, response to therapy was similar to that of other exposure groups. There were no differences in risk of death. If intravenous drug users continue to use HAART less commonly than other exposure groups, it may result in a poorer prognosis, a different spectrum of AIDS-defining illnesses, and differential long-term clinical needs.

Keywords: JOURNAL ARTICLE MULTICENTER STUDY Adult Anti-HIV Agents/*THERAPEUTIC USE Cohort Studies Comparative Study Drug Therapy, Combination Europe Female Heterosexuality Homosexuality Human HIV Infections/*DRUG THERAPY/IMMUNOLOGY/MORTALITY/VIROLOGY *HIV-1 Logistic Models Male Middle Age Proportional Hazards Models Risk Factors Substance Abuse, Intravenous/*COMPLICATIONS Support, Non-U.S. Gov't Survival Analysis Treatment Outcome

KWDjournalarticlemulticenterstudyadultanti-hivagents/KWDtherapeuticusecohortstudiescomparativestudydrugtherapy,combinationeuropefemaleheterosexualityhomosexualityhumanhivinfections/KWDdrugtherapy/immunology/mortality/virologyKWDhiv-1logisticmodelsmalemiddleageproportionalhazardsmodelsriskfactorssubstanceabuse,intravenous/KWDcomplicationssupport,non-uKWDsKWDgov'tsurvivalanalysistreatmentoutcome
000430
A0040855

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