Campa Adriana, Martinez Sabrina Sales, Sherman Kenneth E, Greer Joe Pedro, Li Yinghui, Garcia Stephanie, Stewart Tiffanie, Ibrahimou Boubakari, Williams O Dale, Baum Marianna K
Florida International University, R Stempel College of Public Health and Social Work, Miami, FL, USA.
University of Cincinnati, College of Medicine, Department of Internal Medicine, Cincinnati, Ohio, USA.
J Drug Abuse. 2016;2(4). doi: 10.21767/2471-853X.100036. Epub 2016 Nov 7.
Liver disease is a frequent cause of morbidity and mortality in HIV infection. We examined the relationship of cocaine use, liver disease progression and mortality in an HIV-infected cohort.
Consent was obtained from 487 HIV+ participants, a subset of the Miami Adult Studies on HIV (MASH) cohort. Participants were eligible if they were followed for at least two years, completed questionnaires on demographics and illicit drug use and had complete metabolic panels, CD4 cell counts and HIV-viral loads. FIB-4 was calculated and cut-off points were used for staging liver fibrosis. Death certificates were obtained.
Participants were 65% men, 69% Black and 81% were on ART at recruitment. Cocaine was used by 32% of participants and 29% were HIV/HCV co-infected. Mean age was 46.9 ± 7.7 years, mean CD4 cell count was 501.9 ± 346.7 cells/μL and mean viral load was 2.75 ± 1.3 log copies/mL at baseline. During the follow-up, 27 patients died, with a mortality rate of 28.2/1000 person-year. Cocaine was used by 48% of those who died (specific mortality rate was 13/1000 person-year). Those who died were more likely to use cocaine (HR=3.8, P=0.006) and have more advanced liver fibrosis (HR=1.34, <0.0001), adjusting for age, gender, CD4 cell count and HIV-viral load at baseline and over time. Among the HIV mono-infected participants, cocaine users were 5 times more likely to die (OR=5.09, P=0.006) than participants who did not use cocaine.
Cocaine use and liver fibrosis are strong and independent predictors of mortality in HIV infected and HIV/HCV co-infected adults. Effective interventions to reduce cocaine use among people living with HIV (PHLW) are needed.
肝脏疾病是HIV感染中发病和死亡的常见原因。我们在一个HIV感染队列中研究了可卡因使用、肝脏疾病进展与死亡率之间的关系。
从487名HIV阳性参与者（迈阿密成人HIV研究[MASH]队列的一个子集）处获得了知情同意。如果参与者至少随访两年、完成了关于人口统计学和非法药物使用的问卷并且有完整的代谢指标、CD4细胞计数和HIV病毒载量，则符合条件。计算FIB-4并使用截断点对肝纤维化进行分期。获取了死亡证明。
参与者中65%为男性，69%为黑人，81%在入组时接受抗逆转录病毒治疗（ART）。32%的参与者使用可卡因，29%为HIV/丙型肝炎病毒（HCV）合并感染。基线时平均年龄为46.9±7.7岁，平均CD4细胞计数为501.9±346.7个细胞/微升，平均病毒载量为2.75±1.3 log拷贝/毫升。在随访期间，27名患者死亡，死亡率为28.2/1000人年。48%的死亡者使用可卡因（特定死亡率为13/1000人年）。在对基线和随访期间的年龄、性别、CD4细胞计数和HIV病毒载量进行调整后，死亡者更有可能使用可卡因（风险比[HR]=3.8，P=0.006）且肝纤维化更严重（HR=1.34，P<0.0001）。在HIV单一感染的参与者中，使用可卡因者死亡的可能性是未使用可卡因者的5倍（比值比[OR]=5.09，P=0.006）。
可卡因使用和肝纤维化是HIV感染及HIV/HCV合并感染成人死亡率的强有力且独立的预测因素。需要采取有效的干预措施来减少HIV感染者（PLWH）中的可卡因使用。
