Perello Rafael, Losada Aelajandra, Chen Qin Jiwei, Supervia August, Salgado Emilio, Smithson Alex, Xipell Marc, Inciarte Alexis, Vallecillo Gabriel
Emergency Department, Hospital Clínic, Barcelona, Spain.
Emergency Department, Hospital del Mar, Barcelona, Spain.
HIV Med. 2023 Mar;24(3):260-266. doi: 10.1111/hiv.13365. Epub 2022 Aug 9.
Stimulant drugs, particularly amphetamines, are more commonly implicated in drug-related deaths in people living with HIV; however, the clinical characteristics of amphetamine-related intoxication in people living with HIV are poorly described.
We conducted a retrospective study in people living with HIV who were admitted for amphetamine-related intoxication to an emergency department of a teaching hospital between 2018 and 2021. Severe intoxication (SI) was arbitrarily defined as requiring admission to the emergency medical support unit and receiving medical treatment for ≥6 h.
In total, 170 male patients with a median age of 36.2 + 7.5 years were included in the study. A total of 77 (45.3%) individuals had mental disorders, and 120 (85.7%) had HIV-1 RNA suppression, with a median CD4 cell count of 696 (interquartile range 490-905). In total, 61 (37.9%) individuals were on ritonavir/cobicistat-based regimens. Presenting clinical syndromes included agitation in 60 (35.3%) subjects, anxiety in 37 (21.7%), psychosis in 27 (15.8%), chest pain in 26 (15.3%) and altered level of consciousness in 20 (11.7%). SI was observed in 48 (28.2%) individuals, 12 (7.1%) required admission to the intensive care unit, and two (1.2%) died. Altered level of consciousness (odds ratio [OR] 6.5; 95% confidence interval [CI] 2.2-18.9; p < 0.01), psychosis (OR 5.8; 95% CI 2.2-15.1; p < 0.01) and suicide attempt (OR 4.6; 95% CI 1.8-11.6; p 0.01) were associated with SI in the adjusted analysis.
Amphetamine-related intoxication causes high morbidity in people living with HIV. Healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine-related intoxication.
兴奋剂药物，尤其是苯丙胺类药物，在艾滋病毒感染者与药物相关的死亡中更为常见；然而，艾滋病毒感染者中与苯丙胺相关的中毒的临床特征描述甚少。
我们对2018年至2021年间因与苯丙胺相关的中毒而入住一家教学医院急诊科的艾滋病毒感染者进行了一项回顾性研究。严重中毒（SI）被随意定义为需要入住紧急医疗支持病房并接受≥6小时的治疗。
该研究共纳入170例男性患者，中位年龄为36.2±7.5岁。共有77例（45.3%）个体患有精神障碍，120例（85.7%）实现了HIV-1 RNA抑制，CD4细胞计数中位数为696（四分位间距490-905）。共有61例（37.9%）个体采用基于利托那韦/考比司他的治疗方案。呈现的临床综合征包括60例（35.3%）患者出现躁动、37例（21.7%）出现焦虑、27例（15.8%）出现精神病、26例（15.3%）出现胸痛以及20例（11.7%）出现意识水平改变。48例（28.2%）个体出现严重中毒，12例（7.1%）需要入住重症监护病房，2例（1.2%）死亡。在调整分析中，意识水平改变（比值比[OR]6.5；95%置信区间[CI]2.2-18.9；p<0.01）、精神病（OR 5.8；95%CI 2.2-15.1；p<0.01）和自杀未遂（OR 4.6；95%CI 1.8-11.6；p 0.01）与严重中毒相关。
与苯丙胺相关的中毒在艾滋病毒感染者中导致高发病率。为这些患者提供服务的医疗保健人员应考虑在预防与苯丙胺相关的中毒中纳入减少伤害措施。
