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HIV Therapy Changes Death Demographics

IV drug users at higher risk, but older patients aren't anymore

FRIDAY, Oct. 17, 2003 (HealthDayNews) -- People who acquire the AIDS virus by using tainted drug needles are four times as likely to die over the next decade as those who get infected through sex.

The difference is one of several changes in the demographics of AIDS deaths that have occurred since the introduction of drugs collectively known as highly active antiretroviral therapy, or HAART. Before the arrival of the regimen in late 1996, about half of people with HIV, which causes AIDS, died within 10 years of being diagnosed with the infection. Thanks to HAART, roughly 90 percent of people with HIV now can expect to live at least 10 years with the virus.

HAART "is fantastic. It has increased [survival] significantly," says research leader Kholoud Porter, an epidemiologist specializing in AIDS at the MRC Clinical Trials Unit, in London.

There's nothing unique about the nature of HIV in drug users, Porter says, so their poorer prognosis likely reflects two factors: piggyback infection with other deadly viruses, such as hepatitis C, and spotty adherence to HAART. The second theory is supported by evidence that even while on HAART drug users in the new study typically had much higher levels of HIV in their blood than men and women who acquired the virus through sexual contact. "More of their time on HAART was spent that way," Porter says. "That could point to adherence issues."

Male drug users had a somewhat worse 10-year survival rate than women addicts, the study found.

The findings come from a study of 7,740 men and women in Europe, Australia and Canada infected with HIV. Over time, 2,000, or about a quarter, died. The research appears in the Oct. 18 issue of The Lancet.

Before HAART, people infected with HIV had a much better 10-year prognosis if they caught the infection earlier, in their 30s, say, as against their 50s. That's because the body's immune system wears with age, Porter says, so younger people fight the virus more effectively.

However, since HAART age no longer makes a difference in 10-year survival. No matter when a person is diagnosed with HIV, their odds of living a decade are similarly good.

Mark Milano, a treatment educator at the AIDS Community Research Initiative of America, a New York City nonprofit, believes hepatitis C and limited access to quality health care, not poor adherence, explains the survival gap for HIV-infected drug users. More than 90 percent of injected drug users with HIV also have hepatitis C, Milano says, and the liver virus has become one of the leading causes of death in these patients.

Moreover, it's not necessarily true that injected drug users make worse patients than other people with HIV. "Some studies find they are quite adherent" to HAART. "They have a history of taking things on a regular basis," he says.

As of December 2001, more than 816,000 Americans had been diagnosed with AIDS and nearly 468,000 had died of the disease, according to the U.S. Centers for Disease Control and Prevention.

More information

For more on living with HIV and AIDS, visit the Centers for Disease Control and Prevention or the Gay Men's Health Crisis, a New York City advocacy group.

SOURCES: Kholoud Porter, Ph.D., senior epidemiologist, MRC Clinical Trials Unit, London; Mark Milano, treatment educator, AIDS Community Research Initiative of America, New York City; Oct. 18, 2003, The Lancet
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