Kohli Rakhi, Lo Yungtai, Howard Andrea A, Buono Donna, Floris-Moore Michelle, Klein Robert S, Schoenbaum Ellie E
Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.
Clin Infect Dis. 2005 Sep 15;41(6):864-72. doi: 10.1086/432883. Epub 2005 Aug 16.
Mortality trends among drug users in the era of highly active antiretroviral therapy (HAART) remain unclear.
We examined mortality rates, causes of death, and predictors of mortality in 398 human immunodeficiency virus (HIV)-infected and 656 at-risk drug users for the period of 1996-2001. National death index reports were used to confirm deaths, and causes of death were derived from medical records. Cox proportional hazards models were used to determine factors associated with mortality.
During 1996-2001, mortality rates in HIV-infected and HIV-uninfected participants were 7.3 and 1.5 deaths per 100 person-years, respectively (P<.001). The mean age at the time of death was 43.6 years for HIV-infected subjects and 47.7 years in HIV-uninfected subjects (P<.001). For 398 HIV-infected participants who were observed for 1443 person-years, death rates decreased from 11.4 to 5.4 deaths per 100 person-years over the 6-year period (P=.04). Among all participants, causes of death were as follows: HIV/AIDS, 27% of subjects; substance abuse, 31%; bacterial infection, 25%; other medical illness, 14%; and violence, 3%. Persons who initiated HAART at a CD4+ lymphocyte count of 201-350 cells/mm3 experienced improved survival, compared with those who initiated it at a CD4+ lymphocyte count of < or =200 cells/mm3 (P=.01). In a multivariate Cox model of HIV-infected subjects, factors independently associated with mortality included receipt of HAART (adjusted hazard ratio [HR(adj)], 0.44; 95% confidence interval [CI], 0.28-0.68) and CD4+ lymphocyte count of < or =200 cells/mm3 (HR(adj), 4.23; 95% CI, 2.24-7.60). Use of methadone or illicit drugs did not predict mortality.
To further reduce mortality among drug users, interventions aimed at improving HAART use are warranted. Preventive health and timely management of treatable conditions, such as bacterial infections, also needs emphasis.
在高效抗逆转录病毒治疗（HAART）时代，吸毒者的死亡率趋势仍不明确。
我们调查了1996年至2001年期间398名感染人类免疫缺陷病毒（HIV）的吸毒者和656名有风险的吸毒者的死亡率、死亡原因及死亡预测因素。利用国家死亡指数报告确认死亡情况，死亡原因来自医疗记录。采用Cox比例风险模型确定与死亡率相关的因素。
1996年至2001年期间，感染HIV者和未感染HIV者的死亡率分别为每100人年7.3例和1.5例死亡（P<0.001）。感染HIV者死亡时的平均年龄为43.6岁，未感染HIV者为47.7岁（P<0.001）。对398名感染HIV的参与者进行了1443人年的观察，6年期间死亡率从每100人年11.4例降至5.4例（P=0.04）。在所有参与者中，死亡原因如下：HIV/AIDS，占27%；药物滥用，占31%；细菌感染，占25%；其他疾病，占14%；暴力，占3%。与CD4+淋巴细胞计数≤200个细胞/mm3时开始接受HAART的人相比，CD4+淋巴细胞计数在201-350个细胞/mm3时开始接受HAART的人存活率有所提高（P=0.01）。在感染HIV者的多变量Cox模型中，与死亡率独立相关的因素包括接受HAART（调整后的风险比[HR(adj)]，0.44；95%置信区间[CI]，0.28-0.68）以及CD4+淋巴细胞计数≤200个细胞/mm3（HR(adj)，4.23；95%CI，2.24-7.60）。使用美沙酮或非法药物并不能预测死亡率。
为进一步降低吸毒者的死亡率，有必要采取旨在改善HAART使用情况的干预措施。还需要强调预防性健康以及对可治疗疾病（如细菌感染）的及时管理。
