Early mortality of undiagnosed but prevalent (in 1983-1984) HIV infection in Lothian injectors who tested hepatitis B surface antigen positive (group A) or negative but were high risk for blood-borne virus transmission (group B) in 1983-1984.
OBJECTIVE
To estimate the early death-rate in HIV infected injectors whose HIV infection was during the injection-related HIV outbreak in Lothian region in Scotland in 1983-1984, which was coincident with Hepatitis B transmissions.


METHODS
Regional Virus Laboratory in Edinburgh.


METHODS
Sera from 1983-1984, originally received for Hepatitis B surface antigen testing, from individuals aged 15-55 years who were positive for Hepatitis B surface antigen in 1983-1984 (group A: census) or tested negative but were at high risk for blood-borne virus transmission according to their reason for testing (group B: 50% sample).


METHODS
Survival status of individuals in groups A and B who had not been diagnosed with HIV disease by the end of December 1995 was checked against the deaths' records of the Registrar General for Scotland. Stored sera from 1983-1984 for patients who had died early (that is: in 1983-1984) were tested anonymously for HIV and Hepatitis C antibodies; and prior to testing, causes of death were scored by RPB according to the likelihood of their being HIV or drugs related.


RESULTS
Three early deaths were found in group A patients who were not known to be HIV infected. None of the deaths was likely to be HIV-related; the sera were not tested in order not to risk deductive disclosure. Twenty-four early deaths were found in group B patients who were not known to be HIV-infected, five of whom were both HIV and Hepatitis C antibody positive, and one other was HIV antibody negative but Hepatitis C positive. Reclassification after unlinked anonymous testing and multiplying up of the group B results (to account for 50% sample) gave the early death rate (that is: in 1983-1986) as 15/155 (10%) for HIV-infected drug users (95% CI: 6%-13%).


CONCLUSIONS
Injection-related outbreaks of HIV infection in Lothian in 1983-1984 and at Glenochil Prison in 1993 were each associated with substantial--estimated 10%--early death-rate in HIV-infected injectors. Both HIV outbreaks were coincident with Hepatitis B transmissions, which may be relevant. Further investigations of the death-rate within 2 years of HIV infection are warranted in other exposure categories than injection-related and for injectors who have been immunized against Hepatitis B.
Gore
S M
SM
MRC Biostatistics Unit, Cambridge, U.K.
Brettle
R P
RP
Burns
S M
SM
Lewis
S C
SC
D000293:Adolescent; D000328:Adult; D017848:Blood-Borne Pathogens; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission*; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology / Q000635:transmission*; D006514:Hepatitis B Surface Antigens / Q000097:blood; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D016036:Seroepidemiologic Studies; D015819:Substance Abuse, Intravenous; D015996:Survival Rate
D006514:Hepatitis B Surface Antigens