Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women.
Crack cocaine, disease progression, and mortality in a multicenter cohort of HIV-1 positive women.
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DOI：
10.1097/qad.0b013e32830507f2
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发表时间：
2008-07-11
期刊：
影响因子：
3.8
通讯作者：
Grey, Dennis D.
中科院分区：
文献类型：
--
作者：
Cook, Judith A.;Burke-Miller, Jane K.;Cohen, Mardge H.;Cook, Robert L.;Vlahov, David;Wilson, Tracey E.;Golub, Elizabeth T.;Schwartz, Rebecca M.;Howard, Andrea A.;Ponath, Claudia;Plankey, Michael W.;Levine, Andrea;Grey, Dennis D.
人们对强效可卡因使用模式与人类免疫缺陷病毒 (HIV-1) 疾病进展之间的纵向关联知之甚少，尤其是在女性中。本文探讨了多中心感染女性队列中可卡因使用与 HIV-1 疾病结果之间的关系。受试者为 1686 名 HIV 血清阳性女性，她们在美国六个研究中心参加了女性机构间 HIV 研究。在研究期间，大约 80% 为非白人，29% 为可卡因。 Cox 生存和随机回归分析检查了 1996 年 4 月至 2004 年 9 月期间每两年进行的观察结果。结果指标包括： 因艾滋病相关原因造成的死亡； CD4细胞计数； HIV-1 RNA水平；和新获得的艾滋病定义的疾病。对照自我报告的高活性抗逆转录病毒疗法的依从性、饮酒问题、年龄、种族、收入、教育、病程、研究地点以及基线病毒学和免疫学指标，持续使用快克药物的人死于艾滋病相关原因的可能性是非使用者的三倍多。在控制相同协变量的情况下，持续性破解用户和活跃阶段的间歇性用户表现出更大的 CD4 细胞损失和更高的 HIV-1 RNA 水平。在控制相同的混杂因素的情况下，持续和间歇性的快克使用者比不使用者更有可能患上新的艾滋病定义疾病。当控制海洛因使用、吸烟、抑郁症状、丙型肝炎病毒合并感染和静脉注射毒品使用时，这些结果仍然存在。使用强效可卡因可独立预测女性中与艾滋病相关的死亡率、HIV-1 疾病进展的免疫学和病毒学标记以及艾滋病定义疾病的发展。
Longitudinal associations between patterns of crack cocaine use and progression of human immunodeficiency virus (HIV-1) disease are poorly understood, especially among women. This paper explores relationships between crack use and HIV-1 disease outcomes in a multi-center cohort of infected women. Subjects were 1686 HIV-seropositive women enrolled at six U.S. research centers in the Women’s Interagency HIV Study. Approximately 80% were nonwhite and 29% used crack during the study period. Cox survival and random regression analysis examined bi-annual observations made April 1996 through September 2004. Outcome measures included: death due to AIDS-related causes; CD4 cell count; HIV-1 RNA level; and newly acquired AIDS-defining illnesses. Persistent crack users were over three times as likely as nonusers to die from AIDS-related causes, controlling for use of highly active antiretroviral viral therapies self-reported at >=95% adherence, problem drinking, age, race, income, education, illness duration, study site, and baseline virologic and immunological indicators. Persistent crack users and intermittent users in active phases showed greater CD4 cell loss and higher HIV-1 RNA levels controlling for the same covariates. Persistent and intermittent crack users were more likely than nonusers to develop new AIDS-defining illnesses controlling for identical confounds. These results persisted when controlling for heroin use, tobacco smoking, depressive symptoms, Hepatitis C virus co-infection, and intravenous drug use. Use of crack cocaine independently predicts AIDS-related mortality, immunologic and virologic markers of HIV-1 disease progression, and development of AIDS-defining illnesses among women.