Vallecillo G, Sanvisens A, Martinez E, Torrens M, Bolao F, Tor J, Muga R
Department of Psychiatry, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
Curr HIV Res. 2010 Dec;8(8):641-8. doi: 10.2174/157016210794088272.
Substance abuse greatly impacts the effectiveness of highly active antiretroviral therapy (HAART). We analyzed antiretroviral use in drug users positive for human immunodeficiency virus (HIV) that sought substance abuse treatment.
This cross-sectional study recruited 705 patients HIV positive (74.6% men) between 1997 and 2007. Patients were grouped by calendar periods when different HAART regimens were available in Spain (p1: 1997-1999, n=299; p2: 2000-2003, n=249; and p3: 2004-2007, n=157).
The mean age at admission was 34 years; 94.7% had a past history of injection drug use (IDU) and 67.7% were current IDUs. The average CD4 cell count was 399 cells/µL [interquartile range:203-632 cells/µL]. Lifetime prevalence of antiretroviral use was 59.4% (416/705; p1: 48.1%; p2: 64.6%; p3: 72.6%; p<0.05). The overall prevalence of antiretroviral use at admission was 40.7% (p1: 31.4%; p2: 41.0%; p3: 58.0%; p<0.05). In multivariate logistic regression analysis, age, calendar period, and non-IDU were predictors of antiretroviral use at admission. Among those taking antiretrovirals, 21.6% were on suboptimal HAART, mostly in the p1 group. Overall, 44.6% of patients were taking protease inhibitor and non-nucleoside reverse transcriptase inhibitor (PI-NNRTI), 21.9% were taking NRTI-NNRTI, and 9.4% were taking three NRTIs. Although not significant, the three-NRTI regimen was associated with CD4 >350 cells/µL and HIV RNA <400 copies/mL.
HAART use is steadily increasing in HIV positive heavy drug users. However, part of this population remains antiretroviral therapy-naïve despite advanced immunodeficiency. Interventions that focus on integrating substance abuse with HIV/AIDS treatments are needed.
药物滥用极大地影响了高效抗逆转录病毒疗法（HAART）的疗效。我们分析了寻求药物滥用治疗的人类免疫缺陷病毒（HIV）阳性吸毒者的抗逆转录病毒药物使用情况。
这项横断面研究纳入了1997年至2007年间705例HIV阳性患者（74.6%为男性）。根据西班牙不同HAART方案可用的日历时间段对患者进行分组（p1：1997 - 1999年，n = 299；p2：2000 - 2003年，n = 249；p3：2004 - 2007年，n = 157）。
入院时的平均年龄为34岁；94.7%有注射吸毒史（IDU），67.7%为当前注射吸毒者。平均CD4细胞计数为399个细胞/微升[四分位间距：203 - 632个细胞/微升]。抗逆转录病毒药物的终生使用率为59.4%（416/705；p1：48.1%；p2：64.6%；p3：72.6%；p<0.05）。入院时抗逆转录病毒药物的总体使用率为40.7%（p1：31.4%；p2：41.0%；p3：58.0%；p<0.05）。在多因素逻辑回归分析中，年龄、日历时间段和非注射吸毒者是入院时抗逆转录病毒药物使用的预测因素。在服用抗逆转录病毒药物的患者中，21.6%接受的是次优HAART，主要在p1组。总体而言，44.6%的患者服用蛋白酶抑制剂和非核苷类逆转录酶抑制剂（PI - NNRTI），21.9%服用核苷类逆转录酶抑制剂 - 非核苷类逆转录酶抑制剂（NRTI - NNRTI），9.4%服用三种核苷类逆转录酶抑制剂。虽然不显著，但三种核苷类逆转录酶抑制剂方案与CD4>350个细胞/微升和HIV RNA<400拷贝/毫升相关。
HIV阳性重度吸毒者中HAART的使用在稳步增加。然而，尽管存在严重免疫缺陷，这部分人群中仍有一部分未接受过抗逆转录病毒治疗。需要采取将药物滥用与HIV/AIDS治疗相结合的干预措施。
