title: Ongoing impact of HIV infection on mortality among people who inject drugs despite free antiretroviral therapy.
abstract: OBJECTIVE
  To determine the impact of HIV infection on mortality over time among people who inject drugs (PWID) in settings with free HIV/AIDS care.
  
  
  METHODS
  Prospective cohort study of PWID in Vancouver, Canada, recruited between May 1996 and December 2011. We ascertained morality rates and causes of death through a confidential linkage with the provincial vital statistics registry.
  
  
  METHODS
  A total of 2283 individuals were followed for a median of 60.9 months (interquartile range: 34.4-113.1), among whom 622 (27.2%) individuals were HIV-positive at baseline, and 179 (7.8%) seroconverted during follow-up.
  
  
  METHODS
  The primary and secondary outcomes of interests were all-cause mortality and cause of death, respectively. The main independent variable of interest was HIV serostatus (positive versus negative). We used Cox proportional hazards regression to determine factors associated with mortality, including socio-demographic variables, drug use behaviors and other risk behaviors.
  
  
  RESULTS
  During the study period, 491 (21.5%) individuals died. In multivariate analyses, HIV infection remained associated independently with all-cause mortality (adjusted hazard ratio = 3.15; 95% CI: 2.59-3.82). While all-cause mortality rates declined markedly during the study period (P < 0.001), the independent effect of HIV infection on mortality remained unchanged over time (P = 0.640). Among HIV-positive individuals, significant changes in causes of death from infectious and AIDS-related causes to non-AIDS-related etiologies were observed.
  
  
  CONCLUSIONS
  HIV infection continues to have a persistent impact on mortality rates among people who inject drugs in settings with free HIV/AIDS care, although causes of death have shifted markedly from infectious and AIDS-related causes to non-AIDS-related etiologies.
authors.affiliation: Department of Family Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Leslie
authors.initials: L
authors.lastname: Lappalainen
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.forename: M J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D001955:British Columbia / Q000453:epidemiology; D002423:Cause of Death; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000401:mortality*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011446:Prospective Studies; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000401:mortality*
chemical_list: D019380:Anti-HIV Agents
keywords: HIV/AIDS; Vancouver; free HIV/AIDS care; illicit drug use; injection drug use; mortality; people who inject drugs (PWID)