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Abstract
Role Of HIV-Related Complications In The Trend Of Mortality Of A Homogeneous Cohort Of Over 1,200 Drug Addicts Followed From 1977 To 2002 In A Large Inner City Of Northern Italy
Sabbatani S.1, Agostini D.2, Manfredi R.1
Introduction: Although the introduction of highly active antiretroviral therapy (HAART) determined a dramatic drop of HIV-related morbidity and mortality,both time and trend of deaths among i.V. drug addicts (IVDA) in relation with mode of exposure to HIV,and non-HIV-related deaths,are still unknown.
Methods: A longitudinal 26-year-long study (1977-2002) of a homogeneous cohort of 1214 IVDA of Bologna (Italy), and the cross-comparison of hospital and city registries databases for causes of death and eventual role of underlying HIV infection, were analyzed.
Results: Until December 2002, HIV infection occurred in 49.6% of our patient cohort.Among the 271 registered deaths (22.3%),a mean age of 33.8±6.3 years was found, and the higher risk of death regarded the life interval of 25-34 years. HIV-related disorders and AIDS remained the predominant cause of mortality (52.8% of subjects),followed by drug overdose (22.1%),street accidents (7.4%),decompensated liver cirrhosis (6.3%),suicide (2.9%),heart infectious disorders (2.2%),malignancy (1.8%), and homicide (1.1%). The crude mortality rate due to AIDS proved greater among females (14.4%) versus males (10.9%;p<.05), while deaths due to other causes occurred more frequently among man (12.1%) versus women (5.7%; p<.001). Deaths were significantly concentrated in the 1991-1996 period (14.7%),when a strong relationship with HIV disease was present (p<.0001),but a rapid decline of HIV-associated fatalities occurred since HAART introduction,as demonstrated by a 5-fold reduction of AIDS-related deaths from year 1997 to 2002. The mortality trend of our patient cohort, standardized according to that of the general Bologna population (years 1986-2002),clearly shows the effect of AIDS-related deaths.
Conclusions: Although the crude mortality rate of our large cohort of IVDA living in an Italian metropolitan area followed the trend of AIDS-related diseases and significantly declined since HAART introduction,the case-fatality rate of last years remains greater versus the pre-HIV period. Multiple strategies aimed at limiting life-threatening IVDA complications are to be implemented, together with HIV serology screening, and extensive HAART administration.
The 3rd IAS Conference on HIV Pathogenesis and Treatment
Abstract no.
MoPe11.6C01
Suggested Citation
"SabbataniS., et al.
Role Of HIV-Related Complications In The Trend Of Mortality Of A Homogeneous Cohort Of Over 1,200 Drug Addicts Followed From 1977 To 2002 In A Large Inner City Of Northern Italy.
Poster Exhibition:
The 3rd IAS Conference on HIV Pathogenesis and Treatment:
Abstract no.
MoPe11.6C01"
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