A cohort study revealed high mortality among people who inject drugs in Hai Phong, Vietnam

• Published in: Journal of clinical epidemiology Vol. 139; pp. 38 - 48
• Main Authors: Vinh, Vu Hai, Vallo, Roselyne, Giang, Hoang Thi, Huong, Duong Thi, Oanh, Khuat Thi Hai, Khue, Pham Minh, Thanh, Nham Thi Tuyet, Quillet, Catherine, Rapoud, Delphine, Michel, Laurent, de Perre, Philippe Van, Feelemyer, Jonathan, Moles, Jean Pierre, Cournil, Amandine, Jarlais, Don Des, Laureillard, Didier, Nagot, Nicolas
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Elsevier Limited; Elsevier
• Subjects: Adult; Cohort analysis; Cohort Studies; Comorbidity; Confidence intervals; Death; Drug Users; Drug Users - statistics & numerical data; Drugs; Enrollments; Epidemiology; Female; Hepatitis; Heroin; HIV; HIV Infections; HIV Infections - epidemiology; HIV Infections - mortality; Human health and pathology; Human immunodeficiency virus; Humans; Infectious diseases; Life Sciences; Liver diseases; Male; Medical records; Methadone; Methamphetamine; Middle Aged; Mortality; Mortality risk; Overdose; People who inject drugs; Population; Public health; Santé publique et épidémiologie; Substance Abuse, Intravenous; Substance Abuse, Intravenous - epidemiology; Substance Abuse, Intravenous - mortality; Tuberculosis; Variables; Vietnam; Vietnam - epidemiology; Viral hepatitis; Vietnam; United States > US; South Korea; Viral hepatitis; People who inject drugs; Tuberculosis; HIV; Mortality
• ISSN: 0895-4356; 1878-5921
• DOI: 10.1016/j.jclinepi.2021.07.007

To estimate the residual mortality rate among people who inject drugs (PWID) in a Low-Middle Income Countries context where the HIV epidemic has been controlled and methadone coverage is high. PWID from Haiphong, Vietnam, were recruited through three annual respondent-driven sampling surveys that fueled two cohorts of PWID with HIV (n = 761) and without HIV (n = 897), with bi-annual follow-up. Presumed causes of death were ascertained from medical records and/or interviews of participants family. Among the 1658 participants with a median follow-up of 2 years, 67 and 36 died in the HIV-positive and HIV-negative cohort, respectively, yielding crude mortality rates of 4.3 (95% Confidence interval (CI): 3.3-5.4) per 100 person-years of follow-up (PYFU) and 1.9 (CI: 1.4-2.6) per 100 PYFU. In the HIV-positive cohort, in which 81% of participants had undetectable viral load, the two main causes of death were tuberculosis and HIV-related diseases. In the HIV-negative cohort, the two main causes of death were liver-related diseases and overdose. In a time-dependent multivariable model, “unsuppressed viral load” was associated with increased risk of mortality, whereas “being on methadone” or “being employed” was associated with a lower risk. Despite a very successful HIV and methadone program, the mortality remains high among PWID in Vietnam, largely due to curable infectious diseases such as tuberculosis and viral hepatitis.