Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
AIDS Behav. 2021 Sep;25(9):2951-2962. doi: 10.1007/s10461-021-03162-7. Epub 2021 Feb 10.
Longitudinal analyses of opioid use and overall disease severity among people with HIV (PWH) are lacking. We used joint-trajectory and Cox proportional hazard modeling to examine the relationship between self-reported opioid use and the Veterans Aging Cohort Study (VACS) Index 2.0, a validated measure of disease severity and mortality, among PWH engaged in care. Using data from 2002 and 2018, trajectory modeling classified 20% of 3658 PWH in low (i.e., lower risk of mortality), 40% in moderate, 28% in high, and 12% in extremely high VACS Index trajectories. Compared to those with moderate VACS Index trajectory, PWH with an extremely high trajectory were more likely to have high, then de-escalating opioid use (adjusted odds ratio [AOR], 95% confidence interval [CI] 5·17 [3·19-8·37]) versus stable, infrequent use. PWH who report high frequency opioid use have increased disease severity and mortality risk over time, even when frequency of opioid use de-escalates.
纵向分析艾滋病毒感染者 (PWH) 的阿片类药物使用情况和整体疾病严重程度的数据尚缺乏。我们使用联合轨迹和 Cox 比例风险模型，在接受治疗的 PWH 中，研究了自我报告的阿片类药物使用与退伍军人老龄化队列研究 (VACS) 指数 2.0 之间的关系，该指数是一种经过验证的疾病严重程度和死亡率衡量标准。利用 2002 年和 2018 年的数据，轨迹模型将 3658 名 PWH 中的 20%分为低（即死亡率风险较低）、40%为中、28%为高、12%为极高 VACS 指数轨迹。与具有中度 VACS 指数轨迹的 PWH 相比，具有极高 VACS 指数轨迹的 PWH 更有可能具有较高的阿片类药物使用量，然后逐渐减少（调整后的优势比 [AOR]，95%置信区间 [CI] 5.17 [3.19-8.37]），而不是稳定、不频繁使用。即使阿片类药物使用量减少，报告高频率使用阿片类药物的 PWH 随着时间的推移，疾病严重程度和死亡率风险也会增加。
