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Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial
Developed by Indonesia ITTC
Published on 5/11/2023
Abtract
Abstrak
Introduction
Pendahuluan
The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants.
Penelitian HIV Prevention Trials Network (HPTN) 074 menunjukkan dampak positif dari navigasi sistem terintegrasi dan intervensi konseling psikososial terhadap inisiasi pengobatan HIV, supresi virus, enrolmen medication assisted treatment (MAT; pengobatan dengan obat), dan risiko kematian pada penasun. Dalam bagian penelitian ini, kami menganalisa insiden, penyebab, dan prediktor kematian pada partisipan yang terinfeksi HIV dan yang tidak terinfeksi.
Methods
Metode Penelitian
The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care.
Uji klinis HPTN 074 dilaksanakan di Indonesia, Ukraina, dan Vietnam. Penasun yang terinfeksi HIV dengan viral load tinggi (indeks) direkrut bersama dengan setidaknya satu pasangan menyuntik mereka yang HIV negatif. Indeks dirandomisasi menggunakan rasio 1:3 ke dalam kelompok intervensi atau layanan standar.
Results
Hasil Penelitian
The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1–13.3] and 2.1 [1.3–3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7–39.0] and 5.8 [3.5–9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/μL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5–17.9]), CD4 count (≥ 200 versus < 200 cells/μL aHR = 0.3 [0.2–0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2–5.0]) and study arm (intervention versus control aHR = 0.4 [0.2–0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0–0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9–7.4]).
Uji klinis ini melibatkan 502 indeks dan 806 partner. Secara keseluruhan, 13% (66/502) indeks dan 3% (19/806) partner meninggal selama periode follow-up (crude mortality rates 10.4 [95% CI 8.1–13.3] dan 2.1 [1.3–3.3], berturutan). Angka kematian tersebut bagi indeks mencapai hampir 30x dan bagi partner 6x lebih tinggi dibandingkan pada populasi di negara-negara tersebut, usia, dan gender (standardized mortality ratios 30.7 [23.7–39.0] dan 5.8 [3.5–9.1], berurutan). Penyebab kematian terkait HIV, termasuk CD4 < 200 sel/μL, menyumbang 50% kematian di antara indeks. Pada partner, kondisi medis merupakan penyebab kematian paling umum (47%). Pada model multivariabel Cox, angka kematian pada indeks dikaitkan dengan jenis kelamin (laki-laki versus perempuan aHR = 4.2 [1.5–17.9]), angka CD4 (≥ 200 versus < 200 sel/μL aHR = 0.3 [0.2–0.5]), depresi (sedang – parah versus tidak ada/ringan aHR = 2.6 [1.2–5.0]) dan kelompok penelitian (intervensi versus kontrol aHR = 0.4 [0.2–0.9]) sambil mengendalikan efek MAT (tidak pernah versus pernah menerima MAT aHR = 2.4 [0.9–7.4]).
Conclusions
Kesimpulan
The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.
Hasil analisa menunjukkan bahwa penasun yang terinfeksi dan tidak terinfeksi HIV tetap memiliki risiko kematian yang lebih tinggi dibandingkan populasi umum. Kematian yang berkaitan dengan HIV dan penyebab lainnya dapat dikurangi secara signifikan dengan meningkatkan enrolmen ke ART dan MAT. Akses ke kedua pengobatan yang menyelamatkan jiwa tersebut dapat ditingkatkan secara efektif dengan intervensi terintegrasi yang fleksibel, seperti intervensi yang dikembangkan dan diuji dalam HPTN 074.
Resource Link
https://pubmed.ncbi.nlm.nih.gov/37170118/
Materials
- Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 random
Kostyantyn Dumchev, Xu Guo, Tran Viet Ha, Zubairi Djoerban, Oleksandr Zeziulin, Vivian F. Go,
Riza Sarasvita, David S. Metzger, Carl A. Latkin, Scott M. Rose, Estelle Piwowar-Manning, Paul Richardson, Brett Hanscom, Kathryn E. Lancaster, William C. Miller and Irving F. Hoffman
Related Topics
- Evidence-Based Practices
- HIV/AIDS