Muga Roberto, Langohr Klaus, Tor Jordi, Sanvisens Arantza, Serra Isabel, Rey-Joly Celestino, Muñoz Alvaro
Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Clin Infect Dis. 2007 Aug 1;45(3):370-6. doi: 10.1086/519385. Epub 2007 Jun 19.
In the era of highly active antiretroviral therapy (HAART), it remains unclear whether human immunodeficiency virus (HIV)-infected injection drug users (IDUs) have durations of survival similar to those for comparable HIV-uninfected IDUs. The goal of this study was to compare survival durations of HIV-infected and HIV-uninfected IDUs for the period 1987-2004.Methods. Demographic data, drug use characteristics, and biological markers were obtained at the time of admission to a substance abuse treatment program. The outcome of interest was the duration of survival after admission, and the primary exposure was HIV infection. Vital status was ascertained by means of the mortality register by the end of 2004. Three calendar periods, which were defined on the basis of use of specific therapies, were considered: 1987-1991 (the antiretroviral monotherapy era), 1992-1996 (the dual combination therapy era and the era when methadone was introduced in Spain), and 1997-2004 (the era of HAART and of established methadone programs). We used Cox regression methods allowing for late entries to handle the contribution of persons who survived a given period and entered the following period with nonzero time. We compared HIV-uninfected and HIV-infected IDUs with adjustments for age, sex, and duration of follow-up after admission.
A total of 1209 IDUs were admitted to the hospital during the period from January 1987 through December 2004, and 1181 were eligible for the study. The majority (81.3%) of patients were men. The mean age (+/- standard deviation) at admission was 27.8+/-5.6 years, and the mean duration of injection drug use (+/- standard deviation) was 7.6+/-5.0 years. The prevalences of HIV and hepatitis C virus infections were 59.0% and 92.3%, respectively, and the total duration of follow-up was 10.116 person-years. Although survival duration for HIV-uninfected IDUs in 1997-2004 was similar to the duration in earlier periods, the duration for HIV-infected IDUs improved significantly since 1997 (P<.01). Furthermore, among patients admitted in the last period, the survival durations for HIV-uninfected and HIV-infected IDUs was virtually the same (relative hazard, 0.89; 95% confidence interval, 0.44-1.81).
The duration of survival of HIV-infected IDUs has improved substantially since 1997, reaching rates similar to the rates for HIV-seronegative IDUs who accessed the health care system in the era of HAART.
在高效抗逆转录病毒治疗（HAART）时代，尚不清楚感染人类免疫缺陷病毒（HIV）的注射吸毒者（IDU）的生存时长是否与未感染HIV的类似IDU相同。本研究的目的是比较1987年至2004年期间感染HIV和未感染HIV的IDU的生存时长。
方法。在进入药物滥用治疗项目时获取人口统计学数据、吸毒特征和生物学标志物。感兴趣的结局是入院后的生存时长，主要暴露因素是HIV感染。截至2004年底通过死亡率登记确定生命状态。考虑了根据特定疗法的使用定义的三个日历时间段：1987 - 1991年（抗逆转录病毒单药治疗时代）、1992 - 1996年（联合治疗时代以及西班牙引入美沙酮的时代）和1997 - 2004年（HAART时代和成熟的美沙酮项目时代）。我们使用允许晚期进入的Cox回归方法来处理在给定时期存活并在非零时间进入下一时期的人员的贡献。我们在对年龄、性别和入院后随访时长进行调整后比较了未感染HIV和感染HIV的IDU。
1987年1月至2004年12月期间共有1209名IDU入院，1181名符合研究条件。大多数患者（81.3%）为男性。入院时的平均年龄（±标准差）为27.8±5.6岁，平均注射吸毒时长（±标准差）为7.6±5.0年。HIV和丙型肝炎病毒感染的患病率分别为59.0%和92.3%，总随访时长为10116人年。尽管1997 - 2004年未感染HIV的IDU的生存时长与早期相似，但自1997年以来感染HIV的IDU的生存时长显著改善（P<0.01）。此外，在最后一个时期入院的患者中，未感染HIV和感染HIV的IDU的生存时长几乎相同（相对风险，0.89；95%置信区间，0.44 - 1.81）。
自1997年以来，感染HIV的IDU的生存时长有了显著改善，达到了与HAART时代进入医疗保健系统的HIV血清阴性IDU相似的水平。
