title: Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China.
abstract: BACKGROUND
  Little is known about mortality of opiate users attending methadone maintenance treatment (MMT) clinics. We sought to investigate mortality and its predictors among human immunodeficiency virus (HIV)-positive MMT clients.
  
  
  METHODS
  Records of 306 786 clients enrolled in China's MMT program from 24 March 2004 to 30 April 2011 were abstracted. Mortality rates were calculated for all HIV-positive antiretroviral treatment (ART)-naive and ART-experienced clients. Risk factors were examined using stratified proportional hazard ratios (HRs).
  
  
  RESULTS
  The observed mortality rate for all clients was 11.8/1000 person-years (PY, 95% confidence interval [CI], 11.5-12.1) and 57.2/1000 PY (CI, 54.9-59.4) for HIV-positive clients (n = 18 193). An increase in average methadone doses to >75 mg/day was associated with a 24% reduction in mortality (HR = 0.76, CI, .70-.82), a 48% reduction for ART-naive HIV-positive clients (HR = 0.52, CI, .42-.65), and a 47% reduction for ART-experienced HIV-positive clients (HR = 0.53, CI, .46-.62). Among ART-experienced clients, initiation of ART when the CD4(+) T-cell count was >300 cells/mm(3) (HR = 0.64, CI, .43-.94) was also associated with decreased risk of death.
  
  
  CONCLUSIONS
  We found high mortality rates among HIV-positive MMT clients, yet decreased risk of death, with earlier ART initiation and higher methadone doses. A higher daily methadone dose was associated with reduced mortality in both HIV-infected and HIV-uninfected clients, independent of ART.
authors.affiliation: National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Enwu
authors.initials: E
authors.lastname: Liu
authors.forename: Keming
authors.initials: K
authors.lastname: Rou
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: McGoogan
authors.forename: Lin
authors.initials: L
authors.lastname: Pang
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Cao
authors.forename: Changhe
authors.initials: C
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Luo
authors.forename: Sheena G
authors.initials: SG
authors.lastname: Sullivan
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000401:mortality*; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods*; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000401:mortality*; D016019:Survival Analysis; D055815:Young Adult
chemical_list: D008691:Methadone
keywords: China; HIV; drug users; methadone maintenance treatment; mortality