Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China.
Methadone maintenance treatment and mortality in HIV-positive people who inject opioids in China.
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DOI：
10.2471/blt.12.108944
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发表时间：
2013-02
影响因子：
11.1
通讯作者：
Yan Zhao;C. Shi;J. McGoogan;K. Rou;Fujie Zhang;Zunyou Wu
中科院分区：
文献类型：
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作者：
Yan Zhao;C. Shi;J. McGoogan;K. Rou;Fujie Zhang;Zunyou Wu
目的探讨美沙酮维持治疗（MMT）对中国接受抗逆转录病毒治疗（ART）的阿片类注射者死亡率的影响。该研究涉及23813名在2002年12月31日至2011年12月31日期间接受ART的注射阿片类药物的HIV阳性（HIV+）人群。比较了接受ART和MMT或仅接受ART的患者的死亡率和人口统计学、疾病和治疗特征。通过单因素和多因素分析确定与死亡率相关的因素。总的来说，在41959人-年的随访中发生了3057例死亡（死亡率：7.3/100人-年; 95%置信区间，CI：7.0-7.5）。ART和MMT组开始ART治疗后6个月的死亡率显著低于ART组（分别为6.6和16.9/100人-年; P < 0.001）。12个月后，两组的死亡率分别为3.7和7.4/100人年（P < 0.001）。未接受MMT是死亡的独立预测因素（校正风险比：1.4; 95% CI：1.3-1.6）。其他预测因素是在感染性疾病医院以外的设施开始抗逆转录病毒治疗时血红蛋白水平低和CD 4 + T淋巴细胞计数低。结论患者将受益于MMT和HIV治疗方案，并将面临更少的障碍，照顾，如果方案之间的交叉转诊得到促进和ART和MMT服务位于一起。
OBJECTIVE To examine the effect of methadone maintenance treatment (MMT) on mortality in people injecting opioids who receive antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection in China. METHODS The study involved a nationwide cohort of 23 813 HIV-positive (HIV+) people injecting opioids who received ART between 31 December 2002 and 31 December 2011. Mortality rates and demographic, disease and treatment characteristics were compared in patients who received either ART and MMT or ART only. Factors associated with mortality were identified by univariate and multivariate analysis. FINDINGS Overall, 3057 deaths occurred during 41 959 person-years of follow-up (mortality: 7.3 per 100 person-years; 95% confidence interval, CI: 7.0-7.5). Mortality 6 months after starting ART was significantly lower with ART and MMT than with ART only (6.6 versus 16.9 per 100 person-years, respectively; P < 0.001). After 12 months, mortality was 3.7 and 7.4 per 100 person-years in the two groups, respectively (P < 0.001). Not having received MMT was an independent predictor of death (adjusted hazard ratio: 1.4; 95% CI: 1.3-1.6). Other predictors were a low haemoglobin level and a low CD4+ T-lymphocyte count at ART initiation and treatment at facilities other than infectious disease hospitals. CONCLUSION Patients would benefit more from both MMT and HIV treatment programmes and would face fewer barriers to care if cross-referrals between programmes were promoted and ART and MMT services were located together.