title: HIV treatment outcomes among people who inject drugs in Victoria, Australia.
abstract: BACKGROUND
  People who inject drugs (PWID) are a key population affected by HIV. We assessed the effectiveness of HIV treatment among a clinical cohort of people living with HIV (PLHIV) diagnosed and referred for community-based antiretroviral therapy (ART) in Victoria, Australia.
  
  
  METHODS
  HIV notification data from a central statewide registry were matched with HIV clinical data from two large HIV treatment centers in Melbourne. We used survival analysis and Cox proportional hazard models to estimate time to AIDS and death for PWID in HIV treatment, compared with non-injectors, in the period 1996-2008.
  
  
  RESULTS
  Of the 871 individuals, 93 (10.8%) had injecting as an exposure category and 671 (86%) had ever commenced ART. Adjusted analysis showed younger age, high initial CD4 cell count (>500 cells/mm(3)) or ever having a CD4 cell count >500/mm(3), and more recent calendar year of ART commencement were all associated with reduced hazards for AIDS and death, while older age, low initial CD4 cell count (<200/mm(3)), ever having a CD4 count <200/mm(3) (before or during treatment) and high initial viral load (>5 log10) were associated with increased risk of AIDS and death. PWID were no more likely to experience AIDS (HR 0.98 [0.54-1.80]) or death (HR 0.78 [0.18-3.42]) than non-injectors.
  
  
  CONCLUSIONS
  Survival of HIV-infected PWID on HIV treatment was equivalent to non-injectors. CD4 cell count, initial viral load, calendar year of commencing ART and age are more important determinants of AIDS and mortality than injecting status for in-treatment PLHIV in Victoria, Australia.
authors.affiliation: Department of Epidemiology and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne, Victoria, 3004, Australia. nicktropical@yahoo.com.
authors.forename: Nick
authors.initials: N
authors.lastname: Walsh
authors.affiliation: Department of Medicine, Monash University, Clayton, Victoria, 3065, Australia. anne.mijch@monash.edu.
authors.forename: Anne
authors.initials: A
authors.lastname: Mijch
authors.affiliation: Infection Prevention and Healthcare, Epidemiology Infectious Diseases and Microbiology Unit, Alfred Health, Melbourne, Victoria, 3004, Australia. K.Watson@alfred.org.au.
authors.forename: Kerrie
authors.initials: K
authors.lastname: Watson
authors.affiliation: The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW, 2052, Australia. Hwand@kirby.unsw.edu.au.
authors.forename: Handan
authors.initials: H
authors.lastname: Wand
authors.affiliation: University of Melbourne, Melbourne Sexual Health Centre, Melbourne Sexual Health Centre, 580 Swanston St, Carlton, Victoria, 3053, Australia. cfairley@unimelb.edu.au.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Fairley
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, 89 Commercial Road, Melbourne, Victoria, 3004, Australia. john.mcneil@med.monash.edu.au.
authors.forename: John
authors.initials: J
authors.lastname: McNeil
authors.affiliation: Nossal Institute for Global Health, 4th Floor, 161 Barry St, Carlton, VIC, 3010, Australia. nick.crofts@unimelb.edu.au.
authors.forename: Nick
authors.initials: N
authors.lastname: Crofts
authors.affiliation: The Kirby Institute, Wallace Wurth Building, UNSW Australia, Sydney, NSW, 2052, Australia. lmaher@unsw.edu.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001315:Australia; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012042:Registries; D015819:Substance Abuse, Intravenous / Q000150:complications*; D016896:Treatment Outcome; D014739:Victoria; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents