Gender and Hospitalization Patterns Among HIV-Infected Drug Users Before and After the Availability of Highly Active Antiretroviral Therapy
January 26, 2004
In the era of highly active antiretroviral therapy (HAART), according to the current study, drug users represent a large proportion of persons living with HIV. According to CDC, injection drug use was associated with the acquisition of HIV in 57 percent of women with AIDS and 23.5 percent of men with AIDS in 2000. The rate of HIV infection among U.S. women is growing, with CDC reporting a 138 percent increase in the number of women living with AIDS in 2000.
Studies have shown an increased risk of disease progression and a lower rate of HAART use among HIV-positive women compared to men. Many HIV-positive women who are intravenous drug users (IDUs) are from underprivileged populations and may be at particularly high risk of adverse health outcomes from HIV, the authors noted. Therefore, they surmised, there may be differential morbidity in men and women with HIV.
To investigate morbidity patterns, the researchers examined hospital admissions among 604 HIV-positive IDUs enrolled in a prospective study in Bronx, N.Y., from January 1992-December 2000.
The HIV Epidemiology Research on Outcomes is a prospective cohort study of HIV disease progression and clinical manifestations in current and former opiate-dependent drug users that began in 1985. Participants were recruited from a hospital-affiliated long-term methadone treatment program (MTP).
At semiannual visits, investigators administered structured interviews to obtain demographic information, medical history, and data on use of medications, illicit drugs, and tobacco and the occurrence of any intercurrent hospitalizations. Reports of hospitalizations triggered a review of the hospital records for coded discharge diagnoses. The investigators analyzed data from two periods, January 1992-December 1996 (pre-HAART) and January 1997-December 2000 (the HAART era).
"Three hundred three study participants (50.2 percent) were hospitalized," the study noted, "with a total of 961 hospitalizations. Investigation of patterns of HAART use revealed that 9 persons (4 percent of the eligible population) reported using HAART in 1996. In 1997, this number increased to 69 (32 percent), in 1998, it increased to 111 (46 percent), and in 2000, it increased to 135 (58 percent)."
Eighty-eight percent of study participants in the first period and 100 percent in the second period were undergoing methadone treatment. During the first period, 27 percent of participants reported injecting drugs and 24 percent reported snorting heroin or cocaine. Drug use was similar during the second period and did not differ by race in either period.
The rate of hospitalizations per 100 patient-years in the HAART era was 49.3 compared with 44.1 in the pre-HAART era, the authors found. Among women, the rate was significantly higher in the HAART era than in the pre-HAART era. In the second period, HAART users had lower rates of hospitalization than those not on HAART, for both HIV-related and non-related conditions.
"Among HIV-infected drug users," the scientists wrote, "those who use HAART have a decreased risk of hospitalization; those who do not use HAART remain at high risk of continuing morbidity from both HIV-related and non-HIV-related illness and have high hospitalization rates."
"Further study is needed," the investigators concluded, "to understand the factors underlying gender differences in relation to disease outcomes and utilization of health care services among HIV-infected drug users."
Journal of Acquired Immune Deficiency Syndromes
11.01.03; Michelle Floris-Moore, M.D., M.S.; Yungtai Lo, Ph.D.; Robert S. Kelin, M.D.; Nancy Budner, M.P.H.; Marc N. Gourevitch, M.D., M.P.H.; Galena Moskaleva, M.S.; Ellie E. Schoenbaum, M.D.
This article was provided by U.S. Centers for Disease Control and Prevention. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update. Visit the CDC's website to find out more about their activities, publications and services.