Department of Emergency Medicine, Division of Medical Toxicology, University of California, Los Angeles, Los Angeles, CA, United States.
American College of Medical Toxicology, Phoenix, AZ, United States.
Drug Alcohol Depend. 2024 Nov 1;264:112423. doi: 10.1016/j.drugalcdep.2024.112423. Epub 2024 Sep 7.
Opioid overdose deaths in the U.S. have risen dramatically in the past decade, largely due to the surge in illicitly manufactured fentanyl. Injection drug use is a known risk factor for HIV, further complicating the long-term consequences of opioid use. The baseline prevalence of HIV among adults in the US is 0.46 %. The primary purpose of this study was to determine the prevalence and risk factors of HIV among patients presenting to the emergency departments (ED) with an acute opioid overdose.
This study is a prospective observational cohort study from the ToxIC Fentalog Study group. Patients age 18 years of age or older are included if they present to one of 10 participating U.S. hospitals in 9 states between September 2020 and May 2023 with a suspected opioid overdose and had waste serum available after routine laboratory testing. Clinical data is collected from the medical record and patient serum is sent for comprehensive toxicologic analysis via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect the presence of over 1200 substances including illicit opioids, novel synthetic opioids, medications, and adulterants. Logistic multivariable regression was performed to examine the association between demographic, behavioral, and serum toxicology data with risk factors and HIV status.
Among the total cohort (n=1690), 1062 cases had known HIV status (62.8 % of total sample). Among patients with a known HIV status, 60 (5.6 % [95 % CI: 4.2 %, 7.0 %]) were HIV positive. Patients with HIV reported stimulant use more frequently (13.3 %) than those without HIV (6.8 %; p=0.003). After controlling for confounding, bipolar psychiatric history was a significant independent predictor of HIV positivity (aOR: 1.08; 95 % CI: 1.02, 1.13) in this population.
In this large multicenter cohort, the prevalence of HIV for ED patients with illicit opioid overdose was 9 times higher than that expected by the general population. Bipolar disorder appears to be a novel risk factor for HIV positivity in this patient population.
在美国，阿片类药物过量死亡人数在过去十年中急剧上升，这主要是由于非法制造的芬太尼激增。注射吸毒是艾滋病毒的已知风险因素，这进一步使阿片类药物使用的长期后果复杂化。美国成年人的艾滋病毒基线流行率为 0.46%。这项研究的主要目的是确定在因急性阿片类药物过量而到急诊科就诊的患者中艾滋病毒的流行率和危险因素。
这是 ToxIC Fentalog 研究小组的一项前瞻性观察性队列研究。如果患者在 2020 年 9 月至 2023 年 5 月期间在 9 个州的 10 家参与医院中因疑似阿片类药物过量而出现，并在常规实验室检测后有废物血清可用，则年龄在 18 岁或以上的患者将被纳入研究。从病历中收集临床数据，并通过液相色谱-四极杆飞行时间质谱法对患者血清进行全面毒理学分析，以检测 1200 多种物质的存在，包括非法阿片类药物、新型合成阿片类药物、药物和掺杂物。进行逻辑多变量回归以检查人口统计学、行为和血清毒理学数据与危险因素和 HIV 状况之间的关联。
在总队列（n=1690）中，有 1062 例已知 HIV 状况（总样本的 62.8%）。在已知 HIV 状况的患者中，有 60 例（5.6%[95%CI：4.2%，7.0%]）HIV 阳性。报告使用兴奋剂的 HIV 阳性患者（13.3%）比没有 HIV 的患者（6.8%）更频繁（p=0.003）。在控制混杂因素后，双相情感障碍病史是该人群中 HIV 阳性的显著独立预测因素（aOR：1.08；95%CI：1.02，1.13）。
在这个大型多中心队列中，急诊室因非法阿片类药物过量的患者的 HIV 流行率比一般人群预期的高出 9 倍。双相情感障碍似乎是该患者群体中 HIV 阳性的一个新的危险因素。
