Mathers Bradley M, Degenhardt Louisa
aThe Kirby Institute for Infection and Immunity in Society, Faculty of Medicine bNational Drug and Alcohol Research Centre, University of New South Wales, Sydney cSchool of Population and Global Health, University of Melbourne, Melbourne, Australia.
AIDS. 2014 Nov;28 Suppl 4(4):S435-44. doi: 10.1097/QAD.0000000000000435.
To systematically review and analyse data from cohorts of people who inject drugs (PWID) to improve existing estimates of non-AIDS mortality used to calculate mortality among PWID in the Spectrum Estimates and Projection Package.
Systematic review and meta-analysis.
We conducted an update of an earlier systematic review of mortality among PWID, searching specifically for studies providing data on non-AIDS-related deaths. Random-effects meta-analyses were performed to derive pooled estimates of non-AIDS crude mortality rates across cohorts disaggregated by sex, HIV status and periods in and out of opioid substitution therapy (OST). Within each cohort, ratios of non-AIDS CMRs were calculated and then pooled across studies for the following paired sub-groups: HIV-negative versus HIV-positive PWID; male versus female PWID; periods in OST versus out of OST. For each analysis, pooled estimates by country income group and by geographic region were also calculated.
Thirty-seven eligible studies from high-income countries and five from low and middle-income countries were found. Non-AIDS mortality was significantly higher in low and middle-income countries [2.74 per 100 person-years; 95% confidence interval (CI) 1.76-3.72] than in high-income countries (1.56 per 100 person-years; 95% CI 1.38-1.74). Non-AIDS CMRs were 1.34 times greater among men than women (95% CI 1.14-1.57; N = 19 studies); 1.50 times greater among HIV-positive than HIV-negative PWID (95% CI 1.15, 1.96; N = 16 studies); and more than three times greater during periods out of OST than for periods on OST (N = 7 studies).
A comprehensive response to injecting drug must include efforts to reduce the high levels of non-AIDS mortality among PWID. Due to limitations of currently available data, including substantial heterogeneity between studies, estimates of non-AIDS mortality specific to geographic regions, country income level, or the availability of OST should be interpreted with caution.
系统回顾和分析注射吸毒者队列的数据，以改进用于计算《Spectrum 估计与预测软件包》中注射吸毒者死亡率的非艾滋病死亡率现有估计值。
系统回顾和荟萃分析。
我们对早期关于注射吸毒者死亡率的系统回顾进行了更新，特别搜索提供非艾滋病相关死亡数据的研究。进行随机效应荟萃分析，以得出按性别、艾滋病毒状况以及接受和未接受阿片类药物替代疗法（OST）的时期分类的各队列中非艾滋病粗死亡率的汇总估计值。在每个队列中，计算非艾滋病CMR的比率，然后针对以下配对亚组在各项研究中进行汇总：艾滋病毒阴性与艾滋病毒阳性的注射吸毒者；男性与女性注射吸毒者；接受OST期间与未接受OST期间。对于每项分析，还计算了按国家收入组和地理区域的汇总估计值。
发现来自高收入国家的37项合格研究和来自低收入及中等收入国家的5项合格研究。低收入和中等收入国家的非艾滋病死亡率（每100人年2.74例；95%置信区间[CI]1.76 - 3.72）显著高于高收入国家（每100人年1.56例；95%CI 1.38 - 1.74）。男性的非艾滋病CMR比女性高1.34倍（95%CI 1.14 - 1.57；N = 19项研究）；艾滋病毒阳性的注射吸毒者比艾滋病毒阴性的高1.50倍（95%CI 1.15，1.96；N = 16项研究）；未接受OST期间的非艾滋病CMR比接受OST期间高出三倍多（N = 7项研究）。
应对注射吸毒问题的全面措施必须包括努力降低注射吸毒者中非艾滋病死亡率的高水平。由于现有数据的局限性，包括研究之间存在大量异质性，特定地理区域、国家收入水平或OST可及性的非艾滋病死亡率估计值应谨慎解读。
