Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration
Injection Drug Use and Hepatitis C as Risk Factors for Mortality in HIV-Infected Individuals: The Antiretroviral Therapy Cohort Collaboration
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DOI：
10.1097/qai.0000000000000603
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发表时间：
2015-07-01
影响因子：
3.6
通讯作者：
Sterne, Jonathan A. C.
中科院分区：
文献类型：
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作者：
May, Margaret T.;Justice, Amy C.;Sterne, Jonathan A. C.
背景：有注射毒品（IDU）传播史的HIV感染者的生存率低于其他危险人群。在何种程度上更高的丙型肝炎（HCV）感染率在IDU解释生存differentiations.Methods：成人谁开始抗逆转录病毒治疗在2000年和2009年之间在16个欧洲和北美队列与>70%的完整数据对HCV状态进行了3年的随访。我们估计了未校正和校正（年龄，性别，基线CD 4计数和HIV-1 RNA，抗逆转录病毒治疗前的艾滋病诊断，并按队列分层）IDU（与非IDU）和HCV感染（与HCV未感染）的死亡风险比。结果：32,703例患者中，3374例（10%）为IDU; 4630例（14%）为HCV+; 1116例（3.4%）死亡。IDU组死亡率高于非IDU组[校正HR 2.71; 95%置信区间（CI）：2.32 - 3.16]，HCV+组死亡率高于HCV-组（校正HR 2.65; 95% CI：2.31 - 3.04）。调整HCV后，IDU的影响显著减弱（调整后HR 1.57; 95% CI：1.27 - 1.94），而调整IDU后，HCV影响的减弱不太显著（调整后HR 2.04; 95% CI：1.68 - 2.47）。IDU和HCV均与肝脏相关死亡率密切相关（IDU的校正HR 10.89; 95% CI：6.47 - 18.3，HCV的校正HR 14.0; 95% CI：8.05 - 24.5），IDU的效应衰减更大（校正HR 2.43; 95% CI：1.24 - 4.78）比HCV（校正HR 7.97; 95% CI：3.83 - 16.6）。调整HCV.Conclusions后，注射吸毒者的CNS，呼吸道和暴力死亡率仍然升高：HCV合并感染解释了HIV感染的注射吸毒者的超额死亡率的很大一部分。这些发现强调了新的HCV治疗方法对HIV感染者死亡率的潜在影响。
Background:HIV-infected individuals with a history of transmission through injection drug use (IDU) have poorer survival than other risk groups. The extent to which higher rates of hepatitis C (HCV) infection in IDU explain survival differences is unclear.Methods:Adults who started antiretroviral therapy between 2000 and 2009 in 16 European and North American cohorts with >70% complete data on HCV status were followed for 3 years. We estimated unadjusted and adjusted (for age, sex, baseline CD4 count and HIV-1 RNA, AIDS diagnosis before antiretroviral therapy, and stratified by cohort) mortality hazard ratios for IDU (versus non-IDU) and for HCV-infected (versus HCV uninfected).Results:Of 32,703 patients, 3374 (10%) were IDU; 4630 (14%) were HCV+; 1116 (3.4%) died. Mortality was higher in IDU compared with non-IDU [adjusted HR 2.71; 95% confidence interval (CI): 2.32 to 3.16] and in HCV+ compared with HCV- (adjusted HR 2.65; 95% CI: 2.31 to 3.04). The effect of IDU was substantially attenuated (adjusted HR 1.57; 95% CI: 1.27 to 1.94) after adjustment for HCV, while attenuation of the effect of HCV was less substantial (adjusted HR 2.04; 95% CI: 1.68 to 2.47) after adjustment for IDU. Both IDU and HCV were strongly associated with liver-related mortality (adjusted HR 10.89; 95% CI: 6.47 to 18.3 for IDU and adjusted HR 14.0; 95% CI: 8.05 to 24.5 for HCV) with greater attenuation of the effect of IDU (adjusted HR 2.43; 95% CI: 1.24 to 4.78) than for HCV (adjusted HR 7.97; 95% CI: 3.83 to 16.6). Rates of CNS, respiratory and violent deaths remained elevated in IDU after adjustment for HCV.Conclusions:A substantial proportion of the excess mortality in HIV-infected IDU is explained by HCV coinfection. These findings underscore the potential impact on mortality of new treatments for HCV in HIV-infected people.