TY - JOUR
T1 - Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China
AU - Liu, Enwu
AU - Rou, Keming
AU - McGoogan, Jennifer
AU - Pang, Lin
AU - Cao, Xiaobin
AU - Wang, Changhe
AU - Luo, Wei
AU - Sullivan, Sheena
AU - Montaner, Julio
AU - Butlerys, Marc
AU - Detels, Roger
AU - Wu, Zunyou
PY - 2013/8/1
Y1 - 2013/8/1
N2 - Background. Little is known about mortality of opiate users attending methadone maintenance treatment (MMT) clinics. We sought to investigate mortality and its predictors among human immunodeficiency virus (HIV)-positive MMT clients.Methods. Records of 306 786 clients enrolled in China's MMT program from 24 March 2004 to 30 April 2011 were abstracted. Mortality rates were calculated for all HIV-positive antiretroviral treatment (ART)-naive and ART-experienced clients. Risk factors were examined using stratified proportional hazard ratios (HRs).Results. The observed mortality rate for all clients was 11.8/1000 person-years (PY, 95% confidence interval [CI], 11.5-12.1) and 57.2/1000 PY (CI, 54.9-59.4) for HIV-positive clients (n = 18 193). An increase in average methadone doses to >75 mg/day was associated with a 24% reduction in mortality (HR = 0.76, CI,. 70-.82), a 48% reduction for ART-naive HIV-positive clients (HR = 0.52, CI,. 42-.65), and a 47% reduction for ART-experienced HIV-positive clients (HR = 0.53, CI,. 46-.62). Among ART-experienced clients, initiation of ART when the CD4+ T-cell count was >300 cells/mm3 (HR = 0.64, CI,. 43-.94) was also associated with decreased risk of death.Conclusions. We found high mortality rates among HIV-positive MMT clients, yet decreased risk of death, with earlier ART initiation and higher methadone doses. A higher daily methadone dose was associated with reduced mortality in both HIV-infected and HIV-uninfected clients, independent of ART.
AB - Background. Little is known about mortality of opiate users attending methadone maintenance treatment (MMT) clinics. We sought to investigate mortality and its predictors among human immunodeficiency virus (HIV)-positive MMT clients.Methods. Records of 306 786 clients enrolled in China's MMT program from 24 March 2004 to 30 April 2011 were abstracted. Mortality rates were calculated for all HIV-positive antiretroviral treatment (ART)-naive and ART-experienced clients. Risk factors were examined using stratified proportional hazard ratios (HRs).Results. The observed mortality rate for all clients was 11.8/1000 person-years (PY, 95% confidence interval [CI], 11.5-12.1) and 57.2/1000 PY (CI, 54.9-59.4) for HIV-positive clients (n = 18 193). An increase in average methadone doses to >75 mg/day was associated with a 24% reduction in mortality (HR = 0.76, CI,. 70-.82), a 48% reduction for ART-naive HIV-positive clients (HR = 0.52, CI,. 42-.65), and a 47% reduction for ART-experienced HIV-positive clients (HR = 0.53, CI,. 46-.62). Among ART-experienced clients, initiation of ART when the CD4+ T-cell count was >300 cells/mm3 (HR = 0.64, CI,. 43-.94) was also associated with decreased risk of death.Conclusions. We found high mortality rates among HIV-positive MMT clients, yet decreased risk of death, with earlier ART initiation and higher methadone doses. A higher daily methadone dose was associated with reduced mortality in both HIV-infected and HIV-uninfected clients, independent of ART.
KW - China
KW - drug users
KW - HIV
KW - methadone maintenance treatment
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=84880235576&partnerID=8YFLogxK
U2 - 10.1093/infdis/jit163
DO - 10.1093/infdis/jit163
M3 - Article
SN - 0022-1899
VL - 208
SP - 442
EP - 453
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
IS - 3
ER -