Metcalfe R, Fraser R, Trayner K M A, Glancy M, Yeung A, Sills L, Ritchie T, Priyadarshi S, Peters S E, McAuley A, Hutchinson S
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
NHS Greater Glasgow & Clyde, Glasgow, UK.
HIV Med. 2025 Feb;26(2):265-274. doi: 10.1111/hiv.13733. Epub 2024 Nov 18.
Our aim was to examine mortality trends in the era of antiretroviral therapy, among people who inject drugs (PWID) who are living with HIV. The study objectives were to assess and quantify mortality among PWID diagnosed with HIV over time in Scotland, in the context of a recent outbreak of HIV and rise in drug-related mortality.
This was a retrospective cohort study of those diagnosed with HIV in Scotland between January 2000 and February 2020, with acquisition related to injecting drug use, linked to mortality data. Factors associated with all-cause mortality were examined using Cox proportional hazards regression.
Among 430 individuals with 3143 person-years (py) of follow-up, 88 (20.5%) died. Drug-related deaths accounted for 45.5% of all deaths, rising to 60% among those diagnosed in 2015-2020. The crude all-cause mortality was 28.00 per 1000 py overall and 37.62 per 1000 py within 5 years of diagnosis. Mortality risk was markedly higher among PWID diagnosed in 2015-2020 [adjusted hazard ratio (aHR) = 3.53], relative to those diagnosed in 2000-2004. Among those diagnosed in 2015-2020 (as part of the HIV outbreak), the mortality risk was higher among those not on, compared with those on, opioid agonist therapy (aHR = 3.87).
Mortality among PWID living with HIV in Scotland has risen substantially in the 21st century. Our findings highlight the important role of opioid-agonist therapy, alongside other prevention and treatment measures to address high levels of drug-related mortality for PWID living with HIV, including within HIV outbreaks in this population group.
我们的目标是研究抗逆转录病毒治疗时代，感染艾滋病毒的注射吸毒者（PWID）的死亡率趋势。研究目的是在近期艾滋病毒爆发和与毒品相关的死亡率上升的背景下，评估并量化苏格兰确诊感染艾滋病毒的PWID随时间推移的死亡率。
这是一项回顾性队列研究，研究对象为2000年1月至2020年2月期间在苏格兰确诊感染艾滋病毒且感染与注射吸毒有关的人群，并与死亡率数据相关联。使用Cox比例风险回归分析与全因死亡率相关的因素。
在430名个体中，随访3143人年（py），88人（20.5%）死亡。与毒品相关的死亡占所有死亡的45.5%，在2015 - 2020年确诊的患者中这一比例升至60%。全因粗死亡率总体为每1000人年28.00例，确诊后5年内为每1000人年37.62例。与2000 - 2004年确诊的PWID相比，2015 - 2020年确诊的PWID的死亡风险显著更高[调整后风险比（aHR）= 3.53]。在2015 - 2020年确诊的患者（作为艾滋病毒爆发的一部分）中，未接受阿片类激动剂治疗的患者的死亡风险高于接受治疗的患者（aHR = 3.87）。
21世纪，苏格兰感染艾滋病毒的PWID的死亡率大幅上升。我们的研究结果凸显了阿片类激动剂治疗的重要作用，以及其他预防和治疗措施对于解决感染艾滋病毒的PWID的高毒品相关死亡率的重要性，包括在该人群组的艾滋病毒爆发期间。
