阿片类药物和/或苯二氮䓬类药物的长期处方与HIV感染和未感染患者的死亡率
Long-term Prescription of Opioids and/or Benzodiazepines and Mortality Among HIV-Infected and Uninfected Patients.
作者信息
Weisberg Daniel F, Gordon Kirsha S, Barry Declan T, Becker William C, Crystal Stephen, Edelman Eva J, Gaither Julie, Gordon Adam J, Goulet Joseph, Kerns Robert D, Moore Brent A, Tate Janet, Justice Amy C, Fiellin David A
机构信息
*Yale University School of Medicine, New Haven, CT; †VA Connecticut Healthcare System, West Haven, CT; Departments of ‡Psychiatry; §Internal Medicine, Yale University School of Medicine, New Haven, CT; ‖Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ; ¶Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT; #Yale University School of Public Health, New Haven, CT; **Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; ††VA Pittsburgh Healthcare System, Pittsburgh, PA; and ‡‡Pain Research, Informatics, Multi-morbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT.
出版信息
J Acquir Immune Defic Syndr. 2015 Jun 1;69(2):223-33. doi: 10.1097/QAI.0000000000000591.
BACKGROUND
Increased long-term prescription of opioids and/or benzodiazepines necessitates evaluating risks associated with their receipt. We sought to evaluate the association between long-term opioids and/or benzodiazepines and mortality in HIV-infected patients receiving antiretroviral therapy and uninfected patients.
METHODS
Prospective analysis of all-cause mortality using multivariable methods and propensity score matching among HIV-infected patients receiving antiretroviral therapy and uninfected patients.
RESULTS
Of 64,602 available patients (16,989 HIV-infected and 47,613 uninfected), 27,128 (exposed and unexposed to long-term opioids and/or benzodiazepines) were 1:1 matched by propensity score. The hazard ratio for death was 1.40 [95% confidence interval (CI): 1.22 to 1.61] for long-term opioid receipt, 1.26 (95% CI: 1.08 to 1.48) for long-term benzodiazepine receipt, and 1.56 (95% CI: 1.26 to 1.92) for long-term opioid and benzodiazepine receipt. There was an interaction (P = 0.01) between long-term opioid receipt and HIV status with mortality. For long-term opioid receipt, the hazard ratio was 1.46 (95% CI: 1.15 to 1.87) among HIV-infected patients, and 1.25 (95% CI: 1.05 to 1.49) among uninfected patients. Mortality risk was increased for patients receiving both long-term opioids and benzodiazepines when opioid doses were ≥ 20 mg morphine-equivalent daily dose and for patients receiving long-term opioids alone when doses were ≥ 50 mg morphine-equivalent daily dose.
CONCLUSIONS
Long-term opioid receipt was associated with an increased risk of death; especially with long-term benzodiazepine receipt, higher opioid doses, and among HIV-infected patients. Long-term benzodiazepine receipt was associated with an increased risk of death regardless of opioid receipt. Strategies to mitigate risks associated with these medications, and caution when they are coprescribed, are needed particularly in HIV-infected populations.
背景
阿片类药物和/或苯二氮䓬类药物长期处方的增加，使得有必要评估服用这些药物相关的风险。我们试图评估接受抗逆转录病毒治疗的HIV感染患者以及未感染患者中，长期使用阿片类药物和/或苯二氮䓬类药物与死亡率之间的关联。
方法
采用多变量方法和倾向得分匹配对接受抗逆转录病毒治疗的HIV感染患者以及未感染患者的全因死亡率进行前瞻性分析。
结果
在64,602名可用患者中（16,989名HIV感染患者和47,613名未感染患者），27,128名（长期使用阿片类药物和/或苯二氮䓬类药物的暴露组和未暴露组）通过倾向得分进行了1:1匹配。长期服用阿片类药物的死亡风险比为1.40[95%置信区间（CI）：1.22至1.61]，长期服用苯二氮䓬类药物的死亡风险比为1.26（95%CI：1.08至1.48），长期同时服用阿片类药物和苯二氮䓬类药物的死亡风险比为1.56（95%CI：1.26至1.92）。长期服用阿片类药物与HIV状态在死亡率方面存在交互作用（P = 0.01）。对于长期服用阿片类药物，HIV感染患者的风险比为1.46（95%CI：1.15至1.87），未感染患者的风险比为1.25（95%CI：1.05至1.49）。当阿片类药物剂量≥20毫克吗啡当量每日剂量时，同时长期服用阿片类药物和苯二氮䓬类药物的患者死亡风险增加；当剂量≥50毫克吗啡当量每日剂量时，单独长期服用阿片类药物的患者死亡风险增加。
结论
长期服用阿片类药物与死亡风险增加相关；尤其是同时长期服用苯二氮䓬类药物、阿片类药物剂量较高以及HIV感染患者。无论是否服用阿片类药物，长期服用苯二氮䓬类药物都与死亡风险增加相关。需要采取策略来降低与这些药物相关的风险，并且在联合处方时要谨慎，特别是在HIV感染人群中。
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