The longitudinal pattern and immediacy with which these treatment regimens impact the respective disease courses of HIV and opioid use disorder differ substantially. The relative risk of mortality out of OST is nearly 2.5 times greater than in treatment (2.38 95% CI, 1.79, 3.17). Otherwise, adequately dosed methadone or buprenorphine blocks opioid receptors, satisfies opioid craving, and eliminates withdrawal symptoms while providing a blockade against subsequent opioid administration. 57) for HAART initiators vs noninitiators. HAART protects against mortality, with a hazard ratio of 0.48 (95% CI. HAART stops viral replication, allowing for CD4 cell reconstitution and delay in the onset of AIDS and the otherwise fatal course of HIV/AIDS.
īoth highly active antiretroviral therapy (HAART) and opioid substitution treatment (OST) have been proven to decrease mortality risk substantially within these populations. Comparably, the Antiretroviral Cohort Collaboration reported SMRs for people who inject drugs (PWID) that were 2–4 times higher than noninjection drug users captured within the cohort. A systematic review on mortality among individuals with opioid use disorders reported a standardized mortality ratio (SMR) of 14.66 (95% confidence interval, 12.82, 16.50), with SMRs of HIV-positive opioid users nearly 3 times higher than those of HIV-negative users (relative risk, 2.86 95% CI, 2.18, 3.74). Human immunodeficiency virus (HIV) and opioid use disorder carry a substantial public health burden and a high risk of mortality. (See the Editorial Commentary by Hickman et al on pages 1166–8.) Opioid substitution treatment, injection drug users, highly active antiretroviral therapy, HIV/AIDS, mortality Both OST and HAART independently protected against HIV-related death, drug-related death and death due to other causes.Ĭonclusions. While both OST and HAART are life-saving treatments, joint administration is urgently needed to protect against both drug- and HIV-related mortality.
49) and HAART (0.39 ) decreased the hazard of all-cause mortality however, individuals were at lowest risk of death when these medications were used jointly (0.16 ). Standardized mortality ratios were 12.2 (95% confidence interval, 9.8, 15.0) during OST and 30.0 (27.1, 33.1) during periods out of OST. Results. Among 1727 HIV-positive PWID, 493 (28.5%) died during a median 5.1 years (interquartile range, 2.1–9.1) of follow-up: 18.7% due to drug-related causes, 55.8% due to HIV-related causes, and 25.6% due to other causes.
Methods. Using a linked population-level database for British Columbia, Canada, we used time-to-event analytic methods, including competing risks models, proportional hazards models with time-varying covariates, and marginal structural models, to identify the independent and joint effects of OST and HAART on all-cause as well as drug- and HIV-related mortality, controlling for covariates. We determine the independent and joint effects of OST and HAART on mortality, by cause, within a population of HIV-positive PWID initiating HAART. Background. Prior studies indicated opioid substitution treatment (OST) reduces mortality risk and improves the odds of accessing highly active antiretroviral therapy (HAART) however, the relative effects of these treatments for human immunodeficiency virus (HIV)–positive people who inject drugs (PWID) are unclear.