FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 327:1697-1703 December 10, 1992 Number 24 Next

	Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited Related Article PubMed Citation

Abstract

BACKGROUND AND METHODS. To examine the clinical course of human immunodeficiency virus (HIV) infection in injection-drug users, we conducted a prospective study of a cohort of patients in a methadone-treatment program in New York City from July 1985 through December 1990. The patients underwent standardized evaluations at base line and semiannually thereafter and received on-site primary medical care. Rates of progression to the acquired immunodeficiency syndrome (AIDS) and major outcomes before the development of AIDS were examined by univariate analyses; the risk of AIDS was also assessed by product-limit survival analysis and proportional-hazards regression. RESULTS. Of 318 HIV-seropositive patients who did not yet have AIDS (171 men and 147 women), 90 were black, 179 were Hispanic, and 49 were white; the median age was 33 years. Over a median of 3.0 years of follow-up, 55 (17 percent) received a diagnosis of AIDS (incidence per 100 person-years, 5.8). Major outcomes before the development of AIDS included oral candidiasis (incidence per 100 person-years, 11.2), pyogenic bacterial infections including pneumonia and sepsis (8.0), pulmonary tuberculosis (1.2), multiple constitutional symptoms (13.6), and herpes zoster (1.3). There were 41 deaths from AIDS, and 13 seropositive patients without AIDS (4.1 percent) died of bacterial infections, as compared with only 1 of 411 seronegative patients studied (P < 0.001). The incidence of AIDS was 62 percent lower among those who took zidovudine than among those who did not (P = 0.02). In the multivariate analysis, progression to AIDS was best predicted by low numbers and percentages of CD4+ lymphocytes, nonuse of zidovudine, and the presence of oral candidiasis, bacterial infections, or tuberculosis. There was no consistent relation between progression to disease and the continued use of injection drugs. CONCLUSIONS. HIV-infected injection-drug users have progression to AIDS at rates comparable to those of other HIV-infected groups, but they have substantial pre-AIDS morbidity and mortality, particularly from bacterial infections, which also appear to predict disease progression.

Source Information

Department of Epidemiology and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y.

This article has been cited by other articles:

• Kumar, R., Torres, C., Yamamura, Y., Rodriguez, I., Martinez, M., Staprans, S., Donahoe, R. M., Kraiselburd, E., Stephens, E. B., Kumar, A. (2004). Modulation by Morphine of Viral Set Point in Rhesus Macaques Infected with Simian Immunodeficiency Virus and Simian-Human Immunodeficiency Virus. J. Virol. 78: 11425-11428 [Abstract] [Full Text]  
• Selwyn, P. A., Forstein, M. (2003). Overcoming the False Dichotomy of Curative vs Palliative Care for Late-Stage HIV/AIDS: "Let Me Live the Way I Want to Live, Until I Can't". JAMA 290: 806-814 [Abstract] [Full Text]  
• Palepu, A., Tyndall, M. W., Leon, H., Muller, J., O'Shaughnessy, M. V., Schechter, M. T., Anis, A. H. (2001). Hospital utilization and costs in a cohort of injection drug users. CMAJ 165: 415-420 [Abstract] [Full Text]  
• Laine, C., Hauck, W. W., Gourevitch, M. N., Rothman, J., Cohen, A., Turner, B. J. (2001). Regular Outpatient Medical and Drug Abuse Care and Subsequent Hospitalization of Persons Who Use Illicit Drugs. JAMA 285: 2355-2362 [Abstract] [Full Text]  
• Schwarcz, S. K., Hsu, L. C., Vittinghoff, E., Katz, M. H. (2000). Impact of Protease Inhibitors and Other Antiretroviral Treatments on Acquired Immunodeficiency Syndrome Survival in San Francisco, California, 1987-1996. Am J Epidemiol 152: 178-185 [Abstract] [Full Text]  
• Berger, A. R., Schaumburg, H. H., Gourevitch, M. N., Freeman, K., Herskovitz, S., Arezzo, J. C. (1999). Prevalence of peripheral neuropathy in injection drug users. Neurology 53: 592-592 [Abstract] [Full Text]  
• Richter, A., Brandeau, M. L., Owens, D. K. (1999). An Analysis of Optimal Resource Allocation for Prevention of Infection with Human Immunodeficiency Virus (HIV) in Injection Drug Users and Non-Users. Med Decis Making 19: 167-179 [Abstract]  
• McCORKEL, J. A., BUTZIN, C. A., MARTIN, S. S., INCIARDI, J. A. (1998). Use of Health Care Services in a Sample of Drug-Involved Offenders: A Comparison With National Norms. American Behavioral Scientist 41: 1079-1089 [Abstract]  
• Deacon, N. J., Tsykin, A., Solomon, A., Smith, K., Ludford-Menting, M., Ellett, A., Hooker, D. J., McPhee, D. A., Greenway, A. L., Chatfield, C., Lawson, V. A., Crowe, S., Maerz, A., Sonza, S., Learmont, J., Sullivan, J. S., Cunningham, A., Dwyer, D., Dowton, D., Mills, J. (1995). Genomic Structure of an Attenuated Quasi Species of HIV-1 from a Blood Transfusion Donor and Recipients. Science 270: 988-991 [Abstract]  
• Czachor, J. S., Gleckman, R. A. (1995). Selective Causes of Fever in Adult Human Immunodeficiency Virus--Infected Patients Relative to CD4+ Cell Counts. Arch Fam Med 4: 879-884 [Abstract]  
• Hirschtick, R. E., Glassroth, J., Jordan, M. C., Wilcosky, T. C., Wallace, J. M., Kvale, P. A., Markowitz, N., Rosen, M. J., Mangura, B. T., Hopewell, P. C., The Pulmonary Complications of HIV Infection Study, (1995). Bacterial Pneumonia in Persons Infected with the Human Immunodeficiency Virus. NEJM 333: 845-851 [Abstract] [Full Text]  
• Piette, J., Wachtel, T. J., Mor, V., Mayer, K. (1995). The Impact of Age on the Quality of Life in Persons with HIV Infection. J Aging Health 7: 163-178 [Abstract]  
• O'Connor, P. G., Selwyn, P. A., Schottenfeld, R. S. (1994). Medical Care for Injection-Drug Users with Human Immunodeficiency Virus Infection. NEJM 331: 450-459 [Full Text]