Factors associated with mortality of HIV-positive clients receiving methadone maintenance treatment in China

Background. Little is known about mortality of opiate users attending methadone maintenance treatment (MMT) clinics. We sought to investigate mortality and its predictors among human immunodeficiency virus (HIV)-positive MMT clients.Methods. Records of 306 786 clients enrolled in China's MMT program from 24 March 2004 to 30 April 2011 were abstracted. Mortality rates were calculated for all HIV-positive antiretroviral treatment (ART)-naive and ART-experienced clients. Risk factors were examined using stratified proportional hazard ratios (HRs).Results. The observed mortality rate for all clients was 11.8/1000 person-years (PY, 95% confidence interval [CI], 11.5-12.1) and 57.2/1000 PY (CI, 54.9-59.4) for HIV-positive clients (n = 18 193). An increase in average methadone doses to >75 mg/day was associated with a 24% reduction in mortality (HR = 0.76, CI,. 70-.82), a 48% reduction for ART-naive HIV-positive clients (HR = 0.52, CI,. 42-.65), and a 47% reduction for ART-experienced HIV-positive clients (HR = 0.53, CI,. 46-.62). Among ART-experienced clients, initiation of ART when the CD4⁺ T-cell count was >300 cells/mm³ (HR = 0.64, CI,. 43-.94) was also associated with decreased risk of death.Conclusions. We found high mortality rates among HIV-positive MMT clients, yet decreased risk of death, with earlier ART initiation and higher methadone doses. A higher daily methadone dose was associated with reduced mortality in both HIV-infected and HIV-uninfected clients, independent of ART.