MetroHealth Medical Center and Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH, 44109, USA.
University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Curr HIV/AIDS Rep. 2019 Oct;16(5):381-388. doi: 10.1007/s11904-019-00463-4.
People infected with HIV through injection drug use are more likely to experience progression to AIDS, death due to AIDS, and all-cause mortality even when controlling for access to care and antiretroviral therapy. While high-risk behavior and concurrent infections most certainly are contributors, chronic immune activation, downstream metabolic comorbidities may play an important role.
Altered intestinal integrity plays a major role in HIV-related immune activation and microbial translocation markers are heightened in active heroin users. Additionally, greater injection frequency drives systemic inflammation and is associated with HIV viral rebound. Finally, important systemic inflammation markers have been linked with frailty and mortality in people who inject drugs with and without concurrent HIV infection. Heroin use may work synergistically with HIV infection to cause greater immune activation than either factor alone. Further research is needed to understand the impact on downstream metabolic comorbidities including cardiovascular disease. Medication-assisted treatment for opioid use disorder with methadone or buprenorphine may ameliorate some of this risk; however, there is presently limited research in humans, including in non-HIV populations, describing changes in immune activation on these treatments which is of paramount importance for those with HIV infection.
与经注射吸毒感染 HIV 的人群相比，即使在控制了获得治疗和抗逆转录病毒治疗的机会后，经注射吸毒感染 HIV 的人群更有可能发展为艾滋病、死于艾滋病以及全因死亡率。虽然高危行为和合并感染肯定是促成因素，但慢性免疫激活、下游代谢合并症可能也起着重要作用。
肠道完整性的改变在 HIV 相关免疫激活中起主要作用，且在活跃的海洛因使用者中，肠道微生物易位标志物升高。此外，更高的注射频率会引发全身炎症，并与 HIV 病毒反弹相关。最后，重要的全身炎症标志物与有或没有合并 HIV 感染的吸毒者的虚弱和死亡率有关。海洛因的使用可能与 HIV 感染协同作用，引起比任何单一因素更大的免疫激活。需要进一步的研究来了解对下游代谢合并症（包括心血管疾病）的影响。美沙酮或丁丙诺啡治疗阿片类药物使用障碍的药物辅助治疗可能会减轻部分风险；然而，目前在人类中，包括在非 HIV 人群中，关于这些治疗方法对免疫激活的影响的研究有限，这对感染 HIV 的人群至关重要。
