title: Lack of legal income is strongly associated with an increased risk of AIDS and death in HIV-infected injecting drug users.
abstract: The aim of the study was to analyze the impact of soci-economic status in addition to other risk factors in the progression of HIV disease in a cohort of injecting drug users (IDUs) with a mean follow-up of two years. Between 1989 and 1992, 124 HIV-infected IDUs were recruited in a primary care outpatient clinic providing free consultations and free access to therapy. The main outcome measures were death and AIDs-defining events. The proportion of current daily injectors at entry in the study and at the end of follow-up was 67.7% and 57.2%, respectively. The proportion of individuals on maintenance opioid therapy at entry in the study and at the end of follow-up was 0 and 12.1%, respectively. CD4 cell counts below 200 x 10(6)/L at baseline, positive p24 antigenemia at baseline, the lack of legal income and occasional drug use at entry were risk factors for clinical progression and death. When adjusted in a multivariate analysis, the absence of legal income remained associated with death and occurrence of an AIDS-defining event with a relative risk of 5.2 (1.5-18.1) (p = 0.004). Lack of legal income is a strong risk factor for progression of HIV disease in IDUs, that is independent of CD4 cell count and p24 antigenemia.
authors.affiliation: Unité d'Immunologie, Hôpital Broussais, Université Pierre et Marie Curie, Paris, France. Christophe.piketty@brs.ap-hop-paris.fr
authors.forename: C
authors.initials: C
authors.lastname: Piketty
authors.forename: P
authors.initials: P
authors.lastname: Castiel
authors.forename: P
authors.initials: P
authors.lastname: Giral
authors.forename: J P
authors.initials: JP
authors.lastname: Lhomme
authors.forename: D
authors.initials: D
authors.lastname: Boubilley
authors.forename: C
authors.initials: C
authors.lastname: Olievenstein
authors.forename: F
authors.initials: F
authors.lastname: Lert
authors.forename: M D
authors.initials: MD
authors.lastname: Kazatchkine
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics / Q000209:etiology / Q000401:mortality; D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000191:economics / Q000401:mortality*; D006801:Humans; D007182:Income; D008297:Male; D015999:Multivariate Analysis; D010297:Paris / Q000453:epidemiology; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000191:economics / Q000401:mortality*