179606 Determinants of Progression to AIDS or Death after HIV Diagnosis Among Injection Drug Users in 33 U.S. States, 1996–2004

Monday, October 27, 2008: 3:00 PM

Anna Grigoryan, MD, PhD, MSc , HIV Incidence and Case Surveillance Branch/DHAP, CDC, Atlanta, GA
H. Irene Hall, PhD , HIV Incidence and Case Surveillance Branch/DHAP, Centers for Disease Control and Prevention, Atlanta, GA
Tonji Durant, PhD , HIV Incidence and Case Surveillance Branch/DHAP, CDC, Atlanta, GA
Xiangming Wei, MS , HIV Incidence and Case Surveillance Branch/DHAP, CDC, Atlanta, GA
William K. Adih, MD, MPH, DrPH , Centers for Disease Control and Prevention, HIV Incidence and Case Surveillance Branch, Atlanta, GA
Background: The timeliness of HIV diagnosis and the initiation of antiretroviral treatment are major determinants of survival for HIV-infected people. In 2004, 46% of HIV-infected injection drug users (IDUs) in the United States had a late HIV diagnosis (AIDS diagnosis <12 months after the HIV diagnosis). Our objective was to determine the factors associated with disease progression after HIV diagnosis among IDUs.

Methods: We examined cases of HIV infection among IDUs (aged ≥13 years) from 1996 through 2004 (reported through June 2006), using data from 33 states with confidential name-based HIV reporting. We used standardized Kaplan-Meier survival methods to determine differences in time of progression from HIV to AIDS and death by race/ethnicity, age group, sex, metropolitan residence and diagnosis year.

Results: Of 27,157 IDUs with an HIV diagnosis during 1996¨C2004, 15,293 (56.3%) had a diagnosis of AIDS. Among IDUs, 45.9% of men did not progress to AIDS 3 years after HIV diagnosis (95% CI, 45.6¨C46.2) compared with 54.9% of women (95% CI, 54.5¨C55.2). Risk for progression from HIV to AIDS 36 months after HIV diagnosis among IDUs was greater for nonwhites and older persons compared with whites and younger persons, respectively. At 36 months, fewer IDUs survived who were diagnosed late (76.7, 95% CI, 76.5¨C76.8) compared with non-late testers (93.4, 95% CI, 93.3¨C93.4).

Conclusions: Survival probabilities differed by selected factors among HIV-infected IDUs. To improve their survival, HIV prevention efforts must ensure early HIV testing, access to care, and antiretroviral treatment for IDUs.

Learning Objectives:
1. Perspective participants will understand the problem of late HIV diagnosis and determinants of survival for HIV-infected injection drug users (IDUs). 2. Define “late” HIV diagnosis and understand why IDUs living with HIV received their diagnosis late. 3. Describe the proportion of late HIV diagnosis, determinants of disease progression and survival among the IDU subpopulation using data from the Centers for Disease Control and Prevention’s (CDC) national HIV/AIDS surveillance system. 4. Discuss survival probabilities of HIV-infected IDUs by selected factors as race/ethnicity, age group, sex, metropolitan residence and diagnosis year. 5. Prioritize HIV prevention programs targeting HIV-infected IDUs. 5. Apply gained knowledge to inform and implement HIV prevention efforts, which can contribute to prolonging the lifespan of IDUs living with HIV infection.

Keywords: Drug Use, HIV/AIDS

Presenting author's disclosure statement:

Not Answered

See more of: Critical Issues in HIV-Related Surveillance
See more of: HIV/AIDS