在西班牙，接受阿片类药物替代疗法的 HIV 阳性和 HIV 阴性吸毒者的特定性别疾病结局：一项队列研究。

Sex-specific disease outcomes of HIV-positive and HIV-negative drug users admitted to an opioid substitution therapy program in Spain: a cohort study.

机构信息

Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain.

出版信息

BMC Infect Dis. 2014 Sep 17;14:504. doi: 10.1186/1471-2334-14-504.

DOI:10.1186/1471-2334-14-504

PMID:25231321

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4261781/

Abstract

BACKGROUND

Opioid substitution therapy has improved the survival of heroin users with and without HIV infection. We aimed to analyze sex differences in mortality rates and predictors of death among those admitted to a methadone treatment program (MTP).

METHODS

Longitudinal study of patients enrolled in a MTP from 1992 to 2010. Socio-demographic and drug use characteristics, and markers of viral infections were assessed at entry. Vital status was ascertained by clinical charts and the mortality register. Four calendar periods were defined according to the introduction of preventive and treatment interventions in Spain. Predictors of death were analyzed by Cox regression models.

RESULTS

1,678 patients (82.8% men) were included; age at first heroin use was 18.6 years (IQR: 16-23 years), and age at first entry into a MTP was 30.7 years (IQR: 26-36 years). A total of 441 (26.3%) deaths occurred during 15,124 person-years (p-y) of follow-up (median: 9.2 years, IQR: 4-13 years). HIV infection was the main predictor of death in men (HR = 3.5, 95% CI: 2.1-5.7) and women (HR = 3.2, 95% CI: 1.2-8.7 ) and main cause of death was HIV/AIDS. Overall mortality rate was 2.9 per 100 p-y (95% CI: 2.7-3.2 per 100 p-y) and death rates decreased over time: 7.4 per 100 p-y (95% CI: 6.3-8.8 per 100 p-y) for the 1992-1996 period to 1.9 per 100 p-y (95% CI: 1.6-2.4 per 100 p-y) for the 2007-2010 period. In women, a slightly increase in mortality was observed in recent periods specifically among HIV-positive women (3.7 per 100 p-y in period 2002-2006 and 4.5 per 100 p-y in 2007-2010).

CONCLUSIONS

Significant reductions in mortality of patients in MTP are observed after nineteen years of observation. However, HIV infection shows a great impact on survival, particularly among HIV-infected women.

摘要

背景

阿片类物质替代疗法提高了有和没有 HIV 感染的海洛因使用者的生存率。我们旨在分析接受美沙酮治疗方案（MTP）的患者死亡率和死亡预测因素中的性别差异。

方法

对 1992 年至 2010 年期间参加 MTP 的患者进行纵向研究。在入组时评估社会人口统计学和药物使用特征以及病毒感染标志物。通过临床图表和死亡率登记册确定生存状态。根据西班牙预防和治疗干预措施的引入，定义了四个日历期。通过 Cox 回归模型分析死亡预测因素。

结果

共纳入 1678 名患者（82.8%为男性）；首次使用海洛因的年龄为 18.6 岁（IQR：16-23 岁），首次进入 MTP 的年龄为 30.7 岁（IQR：26-36 岁）。在 15124 人年（p-y）的随访中（中位数：9.2 年，IQR：4-13 年）共发生 441 例（26.3%）死亡。在男性（HR=3.5，95%CI：2.1-5.7）和女性（HR=3.2，95%CI：1.2-8.7）中，HIV 感染是死亡的主要预测因素，也是主要死因是 HIV/AIDS。总体死亡率为每 100 p-y 2.9 例（95%CI：每 100 p-y 2.7-3.2 例），死亡率随时间下降：1992-1996 年每 100 p-y 7.4 例（95%CI：每 100 p-y 6.3-8.8 例）至 2007-2010 年每 100 p-y 1.9 例（95%CI：每 100 p-y 1.6-2.4 例）。在女性中，特别是在 HIV 阳性女性中，最近各期的死亡率略有上升（2002-2006 年期间每 100 p-y 3.7 例，2007-2010 年期间每 100 p-y 4.5 例）。