Differences in progression to AIDS between injection drug users and homosexual men with documented dates of seroconversion.
We compared rates of progression to AIDS for 99 injection drug users and 120 homosexual men with documented dates of HIV-1 seroconversion. The crude risk of developing AIDS was higher among homosexual men than injection drug users [relative hazard (RH) = 2.4; 95% confidence interval (CI) = 1.3-4.4]. The relative hazard was slightly smaller among participants with a seroconversion interval of < or = 1 year (RH = 2.2; 95% CI = 1.0-5.2). The effect was partially explained by the inclusion of Kaposi's sarcoma in the AIDS case definition. Excluding those with Kaposi's sarcoma, the relative hazard was 2.0 (95% CI = 1.1-3.8). Using the 1993 AIDS case definition decreased the effect (RH = 1.9; 95% CI = 1.1-3.4). Finally, the high pre-AIDS mortality among injection drug users could partially explain the difference in progression rate between injection drug users and homosexual men. Combining the effect of the above-mentioned factors resulted in a relative hazard of 1.3 (95% CI = 0.7-2.6). Thus, the slower progression to AIDS among injection drug users compared with homosexual men was largely explained by differences in the spectrum of AIDS-defining illnesses, pre-AIDS mortality, and length of seroconversion interval.
Municipal Health Service, Department of Public Health and Environment, Amsterdam, The Netherlands.
I J
IJ
Spijkerman
M W
MW
Langendam
P J
PJ
Veugelers
E J
EJ
van Ameijden
I P
IP
Keet
R B
RB
Geskus
A
A
van den Hoek
R A
RA
Coutinho
D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality* / Q000503:physiopathology; D018450:Disease Progression; D006679:HIV Seropositivity / Q000503:physiopathology*; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016019:Survival Analysis