National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing, 102206, China.
Bull World Health Organ. 2013 Feb 1;91(2):93-101. doi: 10.2471/BLT.12.108944.
To examine the effect of methadone maintenance treatment (MMT) on mortality in people injecting opioids who receive antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection in China.
The study involved a nationwide cohort of 23 813 HIV-positive (HIV+) people injecting opioids who received ART between 31 December 2002 and 31 December 2011. Mortality rates and demographic, disease and treatment characteristics were compared in patients who received either ART and MMT or ART only. Factors associated with mortality were identified by univariate and multivariate analysis.
Overall, 3057 deaths occurred during 41 959 person-years of follow-up (mortality: 7.3 per 100 person-years; 95% confidence interval, CI: 7.0-7.5). Mortality 6 months after starting ART was significantly lower with ART and MMT than with ART only (6.6 versus 16.9 per 100 person-years, respectively; P < 0.001). After 12 months, mortality was 3.7 and 7.4 per 100 person-years in the two groups, respectively (P < 0.001). Not having received MMT was an independent predictor of death (adjusted hazard ratio: 1.4; 95% CI: 1.3-1.6). Other predictors were a low haemoglobin level and a low CD4+ T-lymphocyte count at ART initiation and treatment at facilities other than infectious disease hospitals.
Patients would benefit more from both MMT and HIV treatment programmes and would face fewer barriers to care if cross-referrals between programmes were promoted and ART and MMT services were located together.
在中国，为治疗人类免疫缺陷病毒（HIV）感染而接受抗逆转录病毒治疗（ART）的阿片类药物注射者中，研究美沙酮维持治疗（MMT）对死亡率的影响。
该研究涉及一个全国性队列，纳入 23813 名 HIV 阳性（HIV+）阿片类药物注射者，他们于 2002 年 12 月 31 日至 2011 年 12 月 31 日期间接受了 ART。比较接受 ART 和 MMT 与仅接受 ART 的患者的死亡率和人口统计学、疾病和治疗特征。通过单因素和多因素分析确定与死亡率相关的因素。
总体而言，在 41959 人年的随访期间发生了 3057 例死亡（死亡率：7.3/100 人年；95%置信区间，CI：7.0-7.5）。与仅接受 ART 相比，ART 联合 MMT 开始后 6 个月的死亡率显著降低（分别为 6.6 和 16.9/100 人年，P<0.001）。12 个月后，两组死亡率分别为 3.7 和 7.4/100 人年（P<0.001）。未接受 MMT 是死亡的独立预测因素（调整后的危险比：1.4；95%CI：1.3-1.6）。其他预测因素是 ART 起始时血红蛋白水平低和 CD4+T 淋巴细胞计数低，以及在传染病医院以外的医疗机构接受治疗。
如果促进项目间的交叉转介，并将 ART 和 MMT 服务集中在一起，患者将从 MMT 和 HIV 治疗项目中获益更多，并面临更少的治疗障碍。
