Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men
Differential Survival Benefit of Universal HAART Access in Brazil: A Nation-Wide Comparison of Injecting Drug Users Versus Men Who Have Sex With Men
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DOI：
10.1097/qai.0b013e3181b31b8a
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发表时间：
2009-12-15
影响因子：
3.6
通讯作者：
Strathdee, Steffanie A.
中科院分区：
文献类型：
--
作者：
Malta, Monica;Bastos, Francisco I.;Strathdee, Steffanie A.
目标：巴西占低收入/中等收入国家接受高效抗逆转录病毒治疗 (HAART) 的注射吸毒者 (IDU) 的 70%。我们评估了HAART的可用性/获取对注射吸毒者与男男性行为者（MSM）中艾滋病相关死亡率的影响。设计：对2000-2006年诊断出患有艾滋病的巴西IDU和MSM进行全国范围的分析。方法：将四个国家信息系统连接起来，并使用Cox回归来评估HAART的可用性/获取对不同的艾滋病相关死亡率的影响。结果：在28,426名患者中，6777人在治疗期间死亡87,792 人年的随访。与 MSM 相比，注射吸毒者接受 HAART 的可能性明显较低，曾经进行过 CD4 或病毒载量测定。控制混杂因素后，IDU 的死亡风险显着较高（调整后风险比：1.94；95% 置信区间：1.84 至 2.05）。在至少有 1 个 CD4 和病毒载量测定的子集中，IDU 的死亡风险仍然较高（风险比：1.82；95% 置信区间：1.58 至 2.11）。非白人种族显着增加了这种风险，而艾滋病诊断后立即接受高效抗逆转录病毒疗法则降低了死亡风险。在控制了空间相关的生存数据后，注射吸毒者中与艾滋病相关的死亡率仍然高于男同性恋者。结论：尽管免费/普遍获得HAART，但巴西与艾滋病相关的死亡率仍存在差异。需要努力查明并消除这些健康差异。
Objective: Brazil accounts for similar to 70% of injection drug users (IDUs) receiving highly active antiretroviral therapy (HAART) in low-income/middle-income countries. We evaluated the impact of HAART availability/access on AIDS-related mortality among IDUs versus men who have sex with men (MSM).Design: Nation-wide analysis on Brazilian IDU and MSM diagnosed with AIDS in 2000-2006.Methods: Four national information systems were linked, and Cox regression was used to assess impact of HAART availability/access on differential AIDS-related mortality.Results: Among 28,426 patients, 6777 died during 87,792 person-years of follow-up. Compared with MSM, IDU were significantly less likely to be receiving HAART, to have ever had determinations for CD4 or viral load. After controlling for confounders, IDU had a significantly higher risk of death (adjusted hazard ratio: 1.94; 95% confidence interval: 1.84 to 2.05). Among the subset that had at least 1 CD4 and viral load determination, higher risk of death among IDU persisted (hazard ratio: 1.82; 95% confidence interval: 1.58 to 2.11). Nonwhite ethnicity significantly increased this risk, whereas prompt HAART uptake after AIDS diagnosis reduced the risk of death. After controlling for spatially correlated survival data, AIDS-related mortality remained higher in IDU than in MSM.Conclusions: Despite free/universal HAART access, differential AIDS-related mortality exists in Brazil. Efforts are needed to identify and eliminate these health disparities.