European Journal of Epidemiology

, Volume 20, Issue 9, pp 795–804 | Cite as

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

  • Liselotte van Asten
  • Robert Zangerle
  • Ildefonso Hernández Aguado
  • Faroudy Boufassa
  • Barbara Broers
  • Raymond P. Brettle
  • J. Roy Robertson
  • Jim McMenamin
  • Roel A. Coutinho
  • Maria Prins
Infectious Diseases

Abstract

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.

Keywords

Europe Highly Active Antiretroviral Therapy HIV disease progression Injecting drug users 

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Copyright information

© Springer 2005

Authors and Affiliations

  • Liselotte van Asten
    • 1
    • 10
  • Robert Zangerle
    • 2
  • Ildefonso Hernández Aguado
    • 3
  • Faroudy Boufassa
    • 4
  • Barbara Broers
    • 5
  • Raymond P. Brettle
    • 6
  • J. Roy Robertson
    • 7
  • Jim McMenamin
    • 8
  • Roel A. Coutinho
    • 1
    • 9
  • Maria Prins
    • 1
  1. 1.Municipal Health ServiceCluster Infectious DiseasesAmsterdamThe Netherlands
  2. 2.AIDS UnitUniversity of InnsbruckInnsbruckAustria
  3. 3.On behalf of the Valencian HIV Seroconversion Study, Department of Public HealthMiguel Hernandez UniversityAlicanteSpain
  4. 4.SEROCO study groupLe Kremlin BicêtreFrance
  5. 5.Division of Infectious DiseasesGeneva University HospitalGenevaSwitzerland
  6. 6.Infectious Diseases UnitWestern General HospitalEdinburghUK
  7. 7.Edinburgh Drug Addiction StudyMuirhouse Medical GroupEdinburghUK
  8. 8.Scottish Center for Infection and Environmental HealthGlasgowScotland
  9. 9.Department of Human Retrovirology, Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
  10. 10.Department for Infectious Diseases Epidemiology (CIE), RIVMNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands

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