British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Int J Drug Policy. 2021 Oct;96:103195. doi: 10.1016/j.drugpo.2021.103195. Epub 2021 Mar 26.
A remarkable reduction in AIDS-related mortality has been achieved through the widespread use of triple combination antiretroviral therapy, considerably increasing the life expectancy of people living with HIV (PLWH). However, these survival gains are now at risk in North America due to an unprecedented public health emergency: the deadly drug overdose epidemic. Drug overdoses are now the leading cause of unintentional death in British Columbia (BC), Canada and the United States due to synthetic opioids (e.g., fentanyl) in illegal markets. This manuscript aimed to estimate the effect of overdose mortality on life expectancy and identify covariates associated with the hazard for overdose mortality in the presence of competing risk among PLWH in BC.
Those eligible were aged ≥20 years, initiated antiretroviral therapy from 1-Apr-1996 to 30-Dec-2017, and were followed until 31-Dec-2017, last contact or death date. We estimated the potential gains in life expectancy from abridged life tables. We modelled the association between covariates and the cause-specific hazard for overdose mortality, accounting for mortality of other causes as a competing risk.
Among the 10,362 PLWH, 3% experienced overdose mortality. The life expectancy at age 20 increased by 8.7 years from 2002-2007 to 2008-2013 compared to only 3.0 years from 2008-2013 to 2014-2017. The potential gain in life expectancy was 3.3 years at age 20 during the ongoing overdose epidemic (2014-2017). There were gender differences in life expectancies throughout the study period. People who have ever injected drugs, women and viral load monitoring non-compliance were key covariates associated with an increased hazard of overdose mortality.
Survival gains among PLWH have been considerably reduced due to the ongoing overdose epidemic.
广泛使用三联抗逆转录病毒疗法显著降低了艾滋病相关死亡率，大大提高了艾滋病毒感染者（PLWH）的预期寿命。然而，由于北美出现了前所未有的公共卫生紧急情况——致命的药物过量流行，这些生存获益现在面临风险。药物过量是导致加拿大不列颠哥伦比亚省（BC）和美国非故意死亡的主要原因，这是由于非法市场上的合成阿片类药物（如芬太尼）造成的。本文旨在估计药物过量死亡率对预期寿命的影响，并确定在 BC 地区 PLWH 存在竞争风险的情况下，与药物过量死亡率相关的协变量。
符合条件的人年龄≥20 岁，于 1996 年 4 月 1 日至 2017 年 12 月 30 日开始接受抗逆转录病毒治疗，并随访至 2017 年 12 月 31 日、最后一次联系或死亡日期。我们使用简略寿命表估计预期寿命的潜在增加。我们建立了协变量与药物过量死亡率的特定原因风险之间的关联模型，同时将其他原因的死亡率作为竞争风险进行考虑。
在 10362 名 PLWH 中，有 3%经历了药物过量死亡。与 2002-2007 年至 2008-2013 年相比，20 岁时的预期寿命增加了 8.7 年，而与 2008-2013 年至 2014-2017 年相比，仅增加了 3.0 年。在当前的药物过量流行期间（2014-2017 年），20 岁时的预期寿命潜在增加了 3.3 年。在整个研究期间，性别差异影响预期寿命。曾经注射过毒品的人、女性和病毒载量监测不遵守规定是与药物过量死亡率增加相关的关键协变量。
由于持续的药物过量流行，PLWH 的生存获益已经大大减少。
