Ferreros Inmaculada, Lumbreras Blanca, Hurtado Isabel, Pérez-Hoyos Santiago, Hernández-Aguado Ildefonso
Unitat d'Epidemiologia i Estadística, Escola Valenciana d'Estudis en Salut (EVES),Valencia, Spain.
Addiction. 2008 Apr;103(4):651-9. doi: 10.1111/j.1360-0443.2008.02135.x.
To monitor changes in cause-specific mortality before and after 1997 according to human immunodeficiency virus (HIV) serological status in a cohort of injecting drug users (IDUs) observed for a 17-year period (1987--2004).
Community-based prospective cohort study of IDUs recruited in three acquired immunodeficiency virus (AIDS) prevention centres (1987--96) and followed-up until to 2004.
We obtained annual overall mortality rates and mortality rates by specific causes according to HIV status. Poisson regression models were adjusted to compare mortality rates between calendar periods. Significant changes in slope trends were evaluated by join-point regression. Disease-specific mortality rates were estimated using competing risk models.
From 7186 IDUs recruited (80677.218 person-years), 1589 deaths were observed with an overall mortality rate of 19.7 per 1000 person-years (95% CI, 18.8-20.7). This rate decreased from 22.9 per 1000 (95% CI, 21.4-24.7) before 1997 to 17.4 per 1000 (95% CI, 16.3-18.6) after 1997 [relative risk (RR) 0.83; 95% confidence interval (CI), 0.75-0.92]. Risk of death for HIV-positive was four times higher than for HIV-negative (RR 4.08; 95% CI, 3.63-4.58). Among HIV-positive individuals a significantly decreased change point in trend was found in 1997 for both total and AIDS mortality. HIV-negative individuals showed a similar pattern for drug overdose, suicide and accident mortality. Both groups showed an increase in proportional mortality by liver-related causes, cardiovascular diseases and cancer. Furthermore, a progressively increasing trend was observed for the three causes. However, there were no significant differences according to serological groups.
Cardiovascular and cancer mortality are increasing among IDUs, but the increases are not related to HIV infection. We have not found a link between highly active antiretroviral therapy (HAART) introduction and increases in mortality for specific causes.
在一个为期17年（1987 - 2004年）的注射吸毒者队列中，根据人类免疫缺陷病毒（HIV）血清学状态监测1997年前后特定病因死亡率的变化。
对在三个获得性免疫缺陷病毒（艾滋病）预防中心招募的注射吸毒者进行基于社区的前瞻性队列研究（1987 - 1996年），并随访至2004年。
我们根据HIV状态获得了年度总死亡率和特定病因的死亡率。采用泊松回归模型比较不同日历时期的死亡率。通过连接点回归评估斜率趋势的显著变化。使用竞争风险模型估计特定疾病的死亡率。
在招募的7186名注射吸毒者中（80677.218人年），观察到1589例死亡，总死亡率为每1000人年19.7例（95%可信区间，18.8 - 20.7）。该比率从1997年前的每1000人年22.9例（95%可信区间，21.4 - 24.7）降至1997年后的每1000人年17.4例（95%可信区间，16.3 - 18.6）[相对风险（RR）0.83；95%置信区间（CI），0.75 - 0.92]。HIV阳性者的死亡风险比HIV阴性者高四倍（RR 4.08；95%可信区间，3.63 - 4.58）。在HIV阳性个体中，1997年发现总死亡率和艾滋病死亡率的趋势均有显著下降的变化点。HIV阴性个体在药物过量、自杀和意外死亡率方面呈现类似模式。两组在与肝脏相关病因、心血管疾病和癌症导致的比例死亡率方面均有所增加。此外，这三种病因呈现出逐渐上升的趋势。然而，根据血清学分组没有显著差异。
注射吸毒者中心血管疾病和癌症死亡率在上升，但这些上升与HIV感染无关。我们未发现引入高效抗逆转录病毒治疗（HAART）与特定病因死亡率增加之间存在关联。
