Mortality is influenced by locality in a major HIV/AIDS epidemic |
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| Authors: | EF Druyts BS Rachlis VD Lima SS Harvard W Zhang EK Brandson SA Strathdee JSG Montaner RS Hogg |
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| Affiliation: | British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada,;Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,;Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada,;Division of International Health and Cross-Cultural Medicine, Faculty of Medicine, University of California, San Diego, CA, USA and;Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada |
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| Abstract: | Objectives The aim of the study was to compare the risks of death among HIV‐infected patients on highly active antiretroviral therapy (HAART) in two proximate, yet distinct neighbourhoods: a neighbourhood with a high concentration of gay men, and a neighbourhood with a high concentration of injecting drug users. Methods We compared the clinical and socioeconomic characteristics of HIV‐infected patients from the two neighbourhoods entering the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 1 September 1997 to 30 November 2005, using contingency table statistics. Cox survival models and Kaplan–Meier methods were used to estimate the cumulative mortality rates. Results We found significant differences between patients from the two neighbourhoods for all socioeconomic variables. Patients in the neighbourhood with a high concentration of injecting drug users were more likely to be female, have a history of injecting drug use, have a less HIV‐experienced physician and be less adherent. Patients in the neighbourhood with a high concentration of gay men were more likely to have AIDS. Mortality was significantly higher for patients in the neighbourhood with a high concentration of injecting drug users [hazard ratio (HR) 3.01; 95% confidence interval (CI) 1.73, 5.24]. Conclusions A threefold increase was observed in the risk of death among HIV‐infected individuals on HAART in the neighbourhood with a high concentration of injecting drug users relative to the neighbourhood with a high concentration of gay men. The implications of this study should be assessed in similar HIV/AIDS epicentres. |
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| Keywords: | antiretroviral therapy HAART HIV/AIDS mortality neighbourhood |
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