title: Impact of hepatitis C infection on long-term mortality of injecting drug users from 1990 to 2002: differences before and after HAART.
abstract: OBJECTIVE
  To assess the impact of HIV and hepatitis C virus (HCV) infection on long-term mortality in injecting drug users (IDU).
  
  
  METHODS
  Community-based prospective cohort study.
  
  
  METHODS
  Mortality data from follow-up in clinical sites and the Mortality Registry by December 2002 were collected for 3247 IDU who attended three centres for voluntary counselling and testing for HIV/AIDS, HCV and hepatitis B virus (HBV) in 1990-1996. Mortality rates by Poisson regression were adjusting for age, sex, duration of drug use, education, HBV and calendar period (1990-1997 and 1998-2002).
  
  
  RESULTS
  Overall, 11.2% were HIV/HCV negative, 43.7% positive only for HCV and 45.1% positive for both. During 26 772 person-years of follow-up, 585 deaths were detected (2.19/100 person-years). Before 1997, HIV/HCV-positive subjects had a five-fold increase in risk of death [relative risk (RR), 5.4; 95% confidence interval (CI), 2.5-11.4] compared with those negative for both; after 1997, a three-fold increase was observed (RR, 2.7; 95% CI, 1.7-4.2). Being HCV positive/HIV negative was not associated with an increase in the risk of death either before (RR, 1.3; 95% CI, 0.6-2.9) or after (RR, 1.2; 95% CI, 0.8-1.9) 1997 compared with HCV/HIV negative. While increases in mortality were seen in those HCV/HIV negative (RR, 1.6; 95% CI, 0.7-3.7) and those only positive for HCV (RR, 1.5; 95% CI, 1.0-2.1), a 20% reduction among coinfected IDUs was observed after 1997 (interaction P = 0.033).
  
  
  CONCLUSIONS
  HCV/HIV coinfection has had a large impact on mortality in IDU. After 1997, mortality increased in HIV negative/HCV positive subjects and decreased in HIV positive/HCV positive.
authors.affiliation: University Miguel Hernández, San Juan de Alicante, Valencia, Spain. blumbreras@umh.es
authors.forename: Blanca
authors.initials: B
authors.lastname: Lumbreras
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Jarrín
authors.forename: Julia
authors.initials: J
authors.lastname: del Amo
authors.forename: Santiago
authors.initials: S
authors.lastname: Pérez-Hoyos
authors.forename: Roberto
authors.initials: R
authors.lastname: Muga
authors.forename: Manuela
authors.initials: M
authors.lastname: García-de la Hera
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Ferreros
authors.forename: Arantza
authors.initials: A
authors.lastname: Sanvisens
authors.forename: Isabel
authors.initials: I
authors.lastname: Hurtado
authors.forename: Ildefonso
authors.initials: I
authors.lastname: Hernández-Aguado
mesh_terms: D000328:Adult; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006526:Hepatitis C / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000401:mortality*; D013997:Time Factors