title: Impact of injecting drug use on mortality in Danish HIV-infected patients: a nation-wide population-based cohort study.
abstract: OBJECTIVE
  To estimate the impact of injecting drug use (IDU) on mortality in HIV-infected patients in the highly active antiretroviral therapy (HAART) era.
  
  
  METHODS
  Population-based, nation-wide prospective cohort study in Denmark (the Danish HIV Cohort Study).
  
  
  METHODS
  A total of 4578 HIV-infected patients were followed from 1 January 1997 or date of HIV diagnosis. We calculated mortality rates stratified on IDU. One-, 5- and 10-year survival probabilities were estimated by Kaplan-Meier methods, and Cox regression analyses were used to estimate mortality rate ratios (MRR).
  
  
  RESULTS
  Of the patients, 484 (10.6%) were categorized as IDUs and 4094 (89.4%) as non-IDUs. IDUs were more likely to be women, Caucasian, hepatitis C virus (HCV) co-infected and younger at baseline; 753 patients died during observation (206 IDUs and 547 non-IDUs). The estimated 10-year survival probabilities were 53.2% [95% confidence interval (CI): 48.1-58.3] in the IDU group and 82.1% (95% CI: 80.7-83.6) in the non-IDU group. IDU as route of HIV infection more than tripled the mortality in HIV-infected patients (MRR: 3.2; 95% CI: 2.7-3.8). Adjusting for potential confounders did not change this estimate substantially. The risk of HIV-related death was not increased in IDUs compared to non-IDUs (MRR 1.1; 95% CI 0.7-1.7).
  
  
  CONCLUSIONS
  Although Denmark's health care system is tax paid and antiretroviral therapy is provided free of charge, HIV-infected IDUs still suffer from substantially increased mortality in the HAART era. The increased risk of death seems to be non-HIV-related and is due probably to the well-known risk factors associated with intravenous drug abuse.
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, DK - 2650 Hvidovre, Denmark. mvlarsen@dadlnet.dk
authors.forename: Mette V
authors.initials: MV
authors.lastname: Larsen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Omland
authors.forename: Jan
authors.initials: J
authors.lastname: Gerstoft
authors.forename: Carsten S
authors.initials: CS
authors.lastname: Larsen
authors.forename: Janne
authors.initials: J
authors.lastname: Jensen
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.forename: Gitte
authors.initials: G
authors.lastname: Kronborg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D003718:Denmark / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000401:mortality*; D055815:Young Adult