ICAAC: Rapid HIV disease progression in injecting drug users in Ukraine

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Over two-thirds of a cohort of HIV-positive injecting drug users in the Ukraine had progressed to AIDS, and over a half had died within five years of HIV seroconversion, according to a study presented to the 44th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington this week.

The natural history of HIV in drug users in the Ukraine has been little studied, even though injecting drug users are the group most affected by HIV in the Ukraine, and large parts of Eastern Europe. An understanding of rates of disease progression is needed to design healthcare interventions.

Data were collected prospectively from a cohort of 100 HIV-positive injecting drug users (66 men and 34 women) in Vinnitsa, Ukraine, with a known date of HIV seroconversion. The investigators calculated the cumulative probability of progression to AIDS and death.

Glossary

person years

In a study “100 person years of follow-up” could mean that information was collected on 100 people for one year, or on 50 people for two years each, or on ten people over ten years. In practice, each person’s duration of follow-up is likely to be different.

seroconversion

The transition period from infection with HIV to the detectable presence of HIV antibodies in the blood. When seroconversion occurs (usually within a few weeks of infection), the result of an HIV antibody test changes from HIV negative to HIV positive. Seroconversion may be accompanied with flu-like symptoms.

 

disease progression

The worsening of a disease.

chemotherapy

The use of drugs to treat an illness, especially cancer.

natural history

The natural development of a disease or condition over time, in the absence of treatment.

Individuals were observed for five years. On entry to the study, the median age was 25.8 years. The drug most frequently used was homemade opiate, with daily injecting widespread.

During the five years of observation 86 individuals progressed to AIDS and 58 died. The cumulative probability of progressing to AIDS at five years was 69%, and 51% for death.

Bacterial infections were the most frequent cause of death (incidence 14.6 per 100 person years), followed by drug-related factors (incidence 8.5 per 100 person years), tuberculosis (incidence 7.6 per 100 person years), and protozoal infections (5.4 per 100 person years).

Men were more likely than women to have progressed to AIDS at five years (80 vs. 60%), and to have died (58 vs. 42%). The investigators also established that older patients were significantly more likely to experience disease progression (data not provided).

The investigators conclude that their data show that injecting drug users in the Ukraine experience faster progression to AIDS and death than that seen in similar populations in the United States and Western Europe.

References

Kyrychenko P et al. The natural history of HIV infection in injection drug users of Vinnitsa, Ukraine. 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, abstract H-1766, 2004.