British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.
BMC Public Health. 2021 Apr 8;21(1):680. doi: 10.1186/s12889-021-10714-y.
Universal provision of effective antiretroviral medication has been essential to reduce mortality, increase longevity, and reduce onward transmission of HIV. This study aims to illuminate persistent threats to the health and longevity of under-served PLWH in British Columbia (BC), Canada.
Between 2007 and 2010, 1000 PLWH across BC were enrolled in the Longitudinal Investigation into Supportive and Ancillary health services (LISA) study and completed a cross-sectional survey on their HIV-care experiences and healthcare engagement. The sample generally reflects an under-served population of PLWH. A linkage to the provincial Vital Statistics registry is used in this analysis in order to examine overall mortality and cause-specific mortality trends; probability of death was modeled using logistic regression for participants with ongoing clinical monitoring (n = 910).
By June 2017, 208 (20.8%) participants had died. The majority of deaths 57 (27.4%) were attributed to drug-related complications or overdoses, 39 (18.8%) were attributed to HIV-related complications, and 36 (17.3%) to non-AIDS-defining malignancies. We observed elevated odds of death among PLWH who smoked tobacco (aOR: 2.11, 95% CI: 1.38, 3.23), were older (aOR: 1.06 per one-year increase, 95% CI: 1.04, 1.08), indicated heavy alcohol consumption (aOR: 1.57, 95% CI: 1.11, 2.22), and reported unstable housing (aOR: 1.96, 95% CI: 1.37, 2.80); while higher CD4 cell count was protective (aOR: 0.87 per 100-unit increase, 95% CI: 0.79, 0.94) as was male gender), though non-significant (aOR: 0.73, 95% CI: 0.49, 1.07).
Overdose is - the leading cause of mortality among a cohort of under-served PLWH in BC, Canada. Public health efforts to end the HIV epidemic and support the health and well-being of PLWH are being thwarted by persistent health inequities and the enormous and persistent risks facing people who use drugs. Integrated low-barrier primary care is essential for supporting under-served PLWH, and safe drug supply is needed to support PLWH who use drugs.
普及有效的抗逆转录病毒药物对于降低死亡率、延长寿命和减少艾滋病毒的传播至关重要。本研究旨在阐明加拿大不列颠哥伦比亚省（BC）服务不足的艾滋病毒感染者（PLWH）的健康和长寿所面临的持续威胁。
在 2007 年至 2010 年期间，BC 地区的 1000 名 PLWH 参加了支持和辅助健康服务的纵向调查（LISA）研究，并完成了一项关于他们的艾滋病毒护理体验和医疗保健参与的横断面调查。该样本总体上反映了服务不足的 PLWH 人群。本分析利用与省级生命统计登记处的链接，以检查总体死亡率和特定原因死亡率趋势；对于有持续临床监测的参与者（n=910），使用逻辑回归模型来预测死亡概率。
截至 2017 年 6 月，208 名（20.8%）参与者死亡。大多数死亡（57 例，27.4%）归因于与药物相关的并发症或过量用药，39 例（18.8%）归因于艾滋病毒相关并发症，36 例（17.3%）归因于非艾滋病定义的恶性肿瘤。我们观察到吸烟（调整后的优势比[aOR]：2.11，95%置信区间[CI]：1.38，3.23）、年龄较大（aOR：每增加一年 1.06，95%CI：1.04，1.08）、大量饮酒（aOR：1.57，95%CI：1.11，2.22）和报告不稳定住房（aOR：1.96，95%CI：1.37，2.80）的 PLWH 死亡风险更高；而较高的 CD4 细胞计数是保护性的（aOR：每增加 100 个单位 0.87，95%CI：0.79，0.94），男性（aOR：0.73，95%CI：0.49，1.07）虽然无统计学意义。
在加拿大不列颠哥伦比亚省（BC）的一个服务不足的 PLWH 队列中，药物过量是导致死亡的主要原因。为结束艾滋病毒流行并支持 PLWH 的健康和福祉而开展的公共卫生努力正受到持续存在的健康不平等和吸毒者面临的巨大和持续风险的阻碍。综合低门槛的初级保健对于支持服务不足的 PLWH 至关重要，需要安全的药物供应来支持使用药物的 PLWH。
