HIV infection and risk of overdose: a systematic review and meta-analysis.
HIV infection and risk of overdose: a systematic review and meta-analysis.
复制标题
DOI：
10.1097/qad.0b013e32834f19b6
复制
发表时间：
2012-02-20
期刊：
影响因子：
--
通讯作者：
Rich JD
中科院分区：
文献类型：
--
作者：
Green TC;McGowan SK;Yokell MA;Pouget ER;Rich JD
吸毒过量是艾滋病毒携带者非艾滋病死亡的常见原因，也是注射吸毒者的主要死亡原因。艾滋病毒携带者在其艾滋病毒护理期间经常接触阿片类药物；其他人可能会继续使用非法阿片类药物，尽管他们的疾病状况。在任何一种情况下，非致命或致命过量服药的风险都可能增加。这种风险升高的潜在机制仍然存在争议。我们系统地回顾了HIV与过量用药相关的文献，荟萃分析结果，并调查了异质性的来源，包括与假设的生物学、行为和结构机制相关的研究特征。回顾了46项研究，其中24项对艾滋病毒状况进行了血清学测量，并提供了量化相关性的数据。Meta分析结果显示，HIV血清阳性与过量死亡的风险增加相关(合并风险比1.74，95%可信区间1.45，2.09)，尽管影响是异质性的(q=80.3，P<；0.01，I2=71%)。研究设计和目标的广泛变异性限制了我们发现潜在的重要异质性来源的能力。文献中考虑的因果机制主要集中在生物和行为因素上，尽管有证据表明，结构性或环境因素可能有助于解释艾滋病毒感染的吸毒者服药过量的更大风险。讨论了未来研究和预防工作的文献中的差距，以及根据这些发现提出的建议。
Drug overdose is a common cause of non-AIDS death among people with HIV and the leading cause of death for people who inject drugs. People with HIV are often exposed to opioid medications during their HIV care experience; others may continue to use illicit opioids despite their disease status. In either situation, there may be a heightened risk for nonfatal or fatal overdose. The potential mechanisms for this elevated risk remain controversial. We systematically reviewed the literature on the HIV–overdose association, meta-analyzed results, and investigated sources of heterogeneity, including study characteristics related to hypothesize biological, behavioral, and structural mechanisms of the association. Forty-six studies were reviewed, 24 of which measured HIV status serologically and provided data quantifying an association. Meta-analysis results showed that HIV seropositivity was associated with an increased risk of overdose mortality (pooled risk ratio 1.74, 95% confidence interval 1.45, 2.09), although the effect was heterogeneous (Q = 80.3, P <0.01, I2 = 71%). The wide variability in study designs and aims limited our ability to detect potentially important sources of heterogeneity. Causal mechanisms considered in the literature focused primarily on biological and behavioral factors, although evidence suggests structural or environmental factors may help explain the greater risk of overdose among HIV-infected drug users. Gaps in the literature for future research and prevention efforts as well as recommendations that follow from these findings are discussed.