Among People with HIV, Those Who Inject Drugs Have an Increased Risk of End-Stage Liver and Renal Disease

With improvements in treatment, HIV-infected individuals are increasingly suffering from HIV-associated non-AIDS (HANA) related comorbidities. Researchers used data from a cohort of people living with HIV to investigate the association between injecting drugs and HANA comorbidities.

• Of the 5490 participants, 2028 (37%) were people who inject drugs (PWID).
• PWID had a higher risk of death before any HANA comorbidity diagnosis, compared with those who did not inject drugs.
• PWID also had a higher risk of end-stage renal or liver disease, compared with those who did not inject drugs.
• The risk of stroke, myocardial infarction, and non-AIDS defining cancers did not differ between PWID those who did not inject drugs.

Comments:

It is important to note that the PWID in this study were those who had injection drug use as their risk factor for HIV infection and did not necessarily currently inject drugs; moreover, some of those who did not report injecting drugs at enrollment may have had used illicit substances or had a current substance use disorder over the course of the study period. The association between injecting drugs and end-stage liver disease is expected given the strong association between injecting behaviors and infection with hepatitis C virus. The finding that end-stage renal disease is also higher among PWID is novel and there is no obvious explanation; this needs to be investigated further.

Darius A. Rastegar, MD

Reference:

Lesko CR, Moore RD, Tong W, Lau B. Association of injection drug use with incidence of HIV-associated non-AIDS-related morbidity by age, 1995–2014. AIDS. 2016;30(9):1447–1455.