INCREASING MORBIDITY WITHOUT RISE IN NON-AIDS MORTALITY AMONG HIV-INFECTED INTRAVENOUS-DRUG-USERS IN AMSTERDAM

Objective: We determined pneumonia, endocarditis, hospitalizations and death rates in a group of HIV-infected and non-infected IVDU recruited at low-threshold methadone programmes in Amsterdam, The Netherlands to examine the influence of HIV infection on morbidity and non-AIDS mortality in intravenous drug users (IVDU) without AIDS. Design: A prospective epidemiologic study among HIV-infected and non-infected IVDU in Amsterdam. Setting: We analysed patients attending the Municipal Health Service of Amsterdam. Patients: The patient group consisted of 197 HIV-seropositive IVDU and 193 HIV-seronegative IVDU as controls. Main outcome measures: We analysed incidence rates per person-year of bacterial pneumonia; hospitalizations and non-AIDS mortality; and relative risks for HIV-infected IVDU compared to non-infected IVDU. Results: The incidence of bacterial pneumonia rose from 0.1 in 1986 to 0.29 in 1989 in HIV-infected IVDU. The overall relative risk for this group was 4.0 (95% confidence interval, 1.7-9.7) compared with non-infected controls. HIV-infected IVDU were more frequently hospitalized for bacterial pneumonia than non-infected IVDU (50 versus 13%). In contrast, non-AIDS mortality, rates remained stable for both HIV-infected and non-infected IVDU. HIV seropositivity was not found to be an independent risk factor for non-AIDS mortality. Conclusion: We found a high and rising incidence of bacterial pneumonia among HIV-infected IVDU in Amsterdam without any consequential rise in non-AIDS mortality. This contrasts with reports from studies conducted in New York City, New York, USA, where bacterial pneumonia-related mortality has been found to increase markedly, coincident with the AIDS epidemic. Early detection of bacterial pneumonia and easy access to both impatient and outpatient medical care may be important factors in preventing early death due to common bacterial pathogens in IVDU without AIDS.