HIV deaths drop 90 percent among African-American IDUs who are given access to combination drug therapy

Combination drug therapy effectively reduces 90 percent of HIV deaths in African-American injection drug users when they are given ample access to care, according to a new Academy study in the June issue of the American Journal of Epidemiology.

Because this disadvantaged population has historically lacked access to pricey multi-drug therapy, there has long been uncertainty about whether it would reduce their late-stage HIV infection and whether these patients could adhere to such a complex treatment regimen.

The results of this important longitudinal study, conducted over the course of 14 years, show that HIV-related deaths nearly disappeared among these minority drug-users when they received access to highly active antiretroviral therapy, or HAART.

“There has been longstanding concern among clinicians and policymakers that some populations may not be good candidates to receive these life-sparing medications,” said lead author David Vlahov, PhD, director of the New York Academy Center for Urban Epidemiologic Studies, and Adjunct Professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health in Baltimore. That concern has been based on anticipation that persons with unstable or marginally stable lifestyles would be less able to adhere to the complex regimens, he said.

“Although medication adherence was not assessed in this study, the dramatic improvement in survival among those on HAART indicates that minority injection drug users are able to follow the drug therapy with success,” Vlahov said. “Access to these drugs should be broadened aggressively both in the U.S. and in developing countries.”

A research team led by Vlahov and including the Academy’s Sandro Galea, MD, DrPh, and scientists from Johns Hopkins and Vanderbilt University School of Medicine, followed 665 minority injection drug users with advanced HIV infection and perilously low CD4 cell counts. Some of the participants were followed for up to 14 years. Before HAART was introduced in 1996 as a standard medical treatment, 15.9 percent of study participants were dying each year. After 1996, when patients in the study received HAART, the annual mortality rate plunged to only 1.2 percent per year.

Two alternative explanations were considered for this dramatic drop in deaths, Vlahov said: that those who survived until at least 1996 were simply stronger and healthier from the start; and, that use of illicit drugs declined as the study progressed. However, additional analyses did not support these alternative explanations, he said.