Mortality is influenced by locality in a major HIV/AIDS epidemic.
OBJECTIVE
The aim of the study was to compare the risks of death among HIV-infected patients on highly active antiretroviral therapy (HAART) in two proximate, yet distinct neighbourhoods: a neighbourhood with a high concentration of gay men, and a neighbourhood with a high concentration of injecting drug users.


METHODS
We compared the clinical and socioeconomic characteristics of HIV-infected patients from the two neighbourhoods entering the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 1 September 1997 to 30 November 2005, using contingency table statistics. Cox survival models and Kaplan-Meier methods were used to estimate the cumulative mortality rates.


RESULTS
We found significant differences between patients from the two neighbourhoods for all socioeconomic variables. Patients in the neighbourhood with a high concentration of injecting drug users were more likely to be female, have a history of injecting drug use, have a less HIV-experienced physician and be less adherent. Patients in the neighbourhood with a high concentration of gay men were more likely to have AIDS. Mortality was significantly higher for patients in the neighbourhood with a high concentration of injecting drug users [hazard ratio (HR) 3.01; 95% confidence interval (CI) 1.73, 5.24].


CONCLUSIONS
A threefold increase was observed in the risk of death among HIV-infected individuals on HAART in the neighbourhood with a high concentration of injecting drug users relative to the neighbourhood with a high concentration of gay men. The implications of this study should be assessed in similar HIV/AIDS epicentres.
Druyts
E F
EF
British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada.
Rachlis
B S
BS
Lima
V D
VD
Harvard
S S
SS
Zhang
W
W
Brandson
E K
EK
Strathdee
S A
SA
Montaner
J S G
JS
Hogg
R S
RS
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000401:mortality*; D001955:British Columbia / Q000453:epidemiology; D002983:Clinical Competence; D004196:Disease Outbreaks; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality*; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012111:Residence Characteristics; D015819:Substance Abuse, Intravenous / Q000401:mortality*; D014505:Urban Population / Q000706:statistics & numerical data; D016903:Drug Monitoring