Infectious Diseases

European Journal of Epidemiology

, Volume 20, Issue 9, pp 795-804

First online:

Do HIV Disease Progression and HAART Response Vary among Injecting Drug Users in Europe?

  • Liselotte van AstenAffiliated withMunicipal Health Service, Cluster Infectious DiseasesDepartment for Infectious Diseases Epidemiology (CIE), RIVM, National Institute for Public Health and the Environment Email author 
  • , Robert ZangerleAffiliated withAIDS Unit, University of Innsbruck
  • , Ildefonso Hernández AguadoAffiliated withOn behalf of the Valencian HIV Seroconversion Study, Department of Public Health, Miguel Hernandez University
  • , Faroudy BoufassaAffiliated withSEROCO study group
  • , Barbara BroersAffiliated withDivision of Infectious Diseases, Geneva University Hospital
  • , Raymond P. BrettleAffiliated withInfectious Diseases Unit, Western General Hospital
  • , J. Roy RobertsonAffiliated withEdinburgh Drug Addiction Study, Muirhouse Medical Group
  • , Jim McMenaminAffiliated withScottish Center for Infection and Environmental Health
  • , Roel A. CoutinhoAffiliated withMunicipal Health Service, Cluster Infectious DiseasesDepartment of Human Retrovirology, Academic Medical Centre, University of Amsterdam
    • , Maria PrinsAffiliated withMunicipal Health Service, Cluster Infectious Diseases

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Prior to HAART availability, there was no evidence of a geographical variation in HIV disease progression among injecting drug users (IDU) from different European regions. Nowadays, factors of importance regarding HIV disease progression in the face of HAART availability, such as HAART access, adherence, and the organization of care for IDU may differ across Europe. Therefore we studied HIV disease progression in a European study of IDU with known dates of HIV-seroconversion. Results show that with ongoing HAART availability, the risk of HIV disease progression has continued to decrease. When accounting for pre-AIDS death (in AIDS analyses) and non-natural deaths (suicide, overdose, accidents and homicide, in analyses of death) which are common among IDU, the risk of AIDS and death has decreased by as much as 65% and 75%, respectively, in 2000/2001. Results show little geographic variation in progression to AIDS. All-cause mortality was higher in IDU from Glasgow than elsewhere, while in the Valencian region (Spain) IDU were at a significantly lower risk of non-natural deaths. The timing of HAART initiation by treatment-naïve IDU likewise differed across Europe: IDU in Amsterdam, Innsbruck, and Edinburgh started at significantly lower CD4 counts than IDU in Paris, Geneva, Glasgow, and the Valencian region, but the subsequent short-term immune response was similar. In conclusion, the risk in progression to AIDS or natural death is similar across western Europe although IDU across Europe differ in other factors, such as the risk of non-natural death and the timing of HAART initiation.


Europe Highly Active Antiretroviral Therapy HIV disease progression Injecting drug users