Effect of hard-drug use on CD4 cell percentage, HIV RNA level, and progression to AIDS-defining class C events among HIV-infected women.
Effect of hard-drug use on CD4 cell percentage, HIV RNA level, and progression to AIDS-defining class C events among HIV-infected women.
复制标题
吸毒对 HIV 感染女性中 CD4 细胞百分比、HIV RNA 水平以及进展为 AIDS 定义的 C 类事件的影响。
DOI：
10.1097/01.qai.0000127354.78706.5d
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Hershow,RonaldC
中科院分区：
文献类型：
--
作者：
Thorpe,LornaE;Frederick,Margaret;Pitt,Jane;Cheng,Irene;Watts,DHeather;Buschur,Shelley;Green,Karen;Zorrilla,Carmen;Landesman,SheldonH;Hershow,RonaldC
体外和动物研究表明，可卡因和海洛因增加了艾滋病毒的复制并抑制了免疫功能，而流行病学研究对它们对艾滋病毒感染进展的影响尚不确定。作者前瞻性地研究了在全国HIV感染妇女队列中，非法药物使用与4项结果指标(CD4细胞百分比、HIV RNA水平、HIV感染C级诊断的存活率和死亡率)之间的关系。1989年至1995年间登记的妇女被跟踪调查了5年，并反复询问有关非法(“硬”)药物使用的情况。多达3次定期尿检证实了自我报告的使用情况。比较了硬吸毒者(使用可卡因、海洛因、美沙酮或注射毒品的女性)和非吸毒者之间的结果，调整了年龄、抗逆转录病毒治疗、怀孕次数、吸烟和基线CD4细胞百分比。在1148名女性中，40%的人报告在怀孕期间使用过基线硬性药物。在多变量分析中，硬药物使用与CD4细胞百分比的变化(P=0.84)、HIV RNA水平(P=0.48)或全因死亡率(相对风险=1.10；95%可信区间0.61-1.98)无关。然而，硬吸毒者确实表现出更高的C级诊断风险(相对风险=1.65；95%可信区间1.00-2.72)，特别是疱疹、肺结核和反复肺炎。使用硬性毒品的女性患非致命性机会性感染的风险可能更高。
In vitro and animal studies suggest that cocaine and heroin increase HIV replication and suppress immune function, whereas epidemiologic studies are inconclusive regarding their effect on HIV infection progression. The authors prospectively examined the association between illicit-drug use and 4 outcome measures (CD4 cell percentage, HIV RNA level, survival to class C diagnosis of HIV infection, and death) in a national cohort of HIV-infected women. Women enrolled between 1989 and 1995 were followed for 5 years and repeatedly interviewed about illicit (“hard”)–drug use. Up to 3 periodic urine screens validated self-reported use. Outcomes were compared between hard-drug users (women using cocaine, heroin, methadone, or injecting drugs) and nonusers, adjusting for age, antiretroviral therapy, number of pregnancies, smoking, and baseline CD4 cell percentage. Of 1148 women, 40% reported baseline hard-drug use during pregnancy. In multivariate analyses, hard-drug use was not associated with change in CD4 cell percentage (P= 0.84), HIV RNA level (P= 0.48), or all-cause mortality (relative hazard= 1.10; 95% confidence interval, 0.61–1.98). Hard-drug users did, however, exhibit a higher risk of developing class C diagnoses (relative hazard= 1.65; 95% confidence interval, 1.00–2.72), especially herpes, pulmonary tuberculosis, and recurrent pneumonia. Hard-drug–using women may have a higher risk for nonfatal opportunistic infections.