HIV感染的静脉吸毒者接受抗病毒治疗和美沙酮治疗效果评价
发布时间：2018-02-14 00:28
本文关键词： 人类免疫缺陷病毒 静脉注射吸毒者 抗反转录病毒治疗 美沙酮维持治疗 出处：《中国疾病预防控制中心》2013年博士论文 论文类型：学位论文
【摘要】：背景HIV感染的静脉注射吸毒者(Injecting drug users, IDUs)(以下简称"HIV吸毒者”)的管理和治疗仍然是棘手的公共卫生问题,美沙酮维持治疗(Methadone maintenance treatment, MMT)和抗反转录病毒治疗(Antiretroviral therapy, ART)是改善HIV吸毒者生存状况的重要手段。现有科学证据表明,MMT可以增加HIV吸毒者的ART覆盖率和依从性,降低病死率。中国建立了国家MMT及ART项目,两个项目的各自效果都有评价,但是对合并治疗者的效果评价鲜有报告。 目的分析HIV吸毒者接受ART及MMT的效果及影响因素。 方法以HIV吸毒者为研究对象,建立两个观察性研究队列。以29个抗病毒治疗门诊在2011年达治疗标准(CD4350个/μl)的所有初治HIV吸毒者为研究对象,建立抗病毒治疗队列。对合并使用ART与MMT的患者所在的63个美沙酮门诊中2011年内所有符合ART标准(CD4350个/μl)的患者为研究对象,建立美沙酮治疗队列。合并使用ART和MMT者同时包括在两个队列中。前瞻性随访观察1年,对抗病毒治疗队列的病死率、病毒载量抑制功率及影响因素进行分析；对美沙酮治疗队列的病死率、MMT维持率及相关影响因素进行分析。 结果抗病毒治疗队列共入选1633例HIV吸毒者,其中324例合并使用MMT,625例仍在使用毒品,684例未使用毒品。整个队列随访观察1年,80.3%在治,13.5%退出,6.2%死亡。MMT组、未使用毒品组、使用毒品组病死率分别为5.5、1.7、15.2/百人年。对死亡影响因素进行Cox比例风险模型多因素回归分析：无业死亡风险最高[AHR=23.5(95%CI:3.3-170.4)];其它影响因素包括使用毒品[AHR=6.2(95%CI:3.1-12.3)]或MMT [AHR=2.7(95%CI:1.2-6.0)]、低级别治疗机构[县级:AHR=6.2(95%CI:1.7-23.0),地市级：AHR=4.9(95%CI:1.3-17.9)]、男性[AHR=2.2(95%CI:1.1-4.5)、血红蛋的120g/l[AHR=2.2(95%CI:1.4-3.3)]. CD4200个/μl [AHR=2.1(95%CI:1.3-3.4)]。 1070例有1年病毒载量结果,血浆病毒载量抑制率(400拷贝/ml)达到83.6%。其中,未使用毒品组的病毒载量抑制率最高,为87.7%,MMT组与使用毒品组的病毒抑制率相同,均为79.6%。对患者病毒载量抑制失败的多因素logistic回归分析中,未婚或离异[AOR=1.63(95%CI:1.13-2.35)]、无工作[AOR=1.64(95%CI:1.05-2.56)]、少数民族[AOR=1.95(95%CI:1.33-2.88)],使用毒品[AOR=1.68(95%CI:1.10-2.57)]或MMT [AOR=1.65(95%CI:1.02-2.66)],在疾控中心门诊治疗[AOR=2.53(95%CI:1.30-4.94)]均增加病毒载量抑制失败风险。 美沙酮治疗队列509名患者中包括324例合并使用MMT及ART者,还有185例未接受ART的患者。随访1年,ART组总病死率为5.5/百人年,无ART组总病死率7.4/百人年。对死亡影响因素进行Cox比例风险模型回归分析：CD4200个/μl是唯一的死亡影响因素[AHR=5.5(95%CI:2.2-13.9)]。 美沙酮治疗队列观察1年,ART组美沙酮使用剂量为72.8(IQR:50.3-106.9)mg/日,维持率66.1%(IQR:26.2%-94.0%);无ART组剂量55.7(IQR:35.3-80.0)mg/日,维持率60.9%(IQR：9.8%-92.1%)。影响美沙酮高维持率(≥50%)的多因素Logistic回归分析：高剂量(≥60mg/日)与维持率明显相关[AOR=3.07(95%CI:2.06-4.57)],其它有统计学意义的因素是CD4：200-350个/μl [AOR=1.60(95%CI:1.07-2.39)]。 结论对于HIV吸毒患者来说,如果停止使用毒品,可以取得最佳的抗病毒治疗效果；与使用毒品相比,MMT明显降低患者病死率。但是,使用MMT或毒品的患者病毒载量抑制率学效果有待提高。美沙酮治疗维持率与美沙酮服用剂量相关,ART不会降低美沙酮治疗维持率。 今后应该加强ART机构与MMT机构的整合和协作,以改善这两个项目的卫生质量。关注改善美沙酮与抗病毒药物相互作用,美沙酮门诊监督服抗病毒药物等措施。对于就业、医疗机构治疗水平等因素也要重视。
[Abstract]:Background intravenous drug users infected with HIV (Injecting drug users, IDUs) (hereinafter referred to as "HIV addicts") management and treatment is still a public health problem difficult, methadone maintenance treatment (Methadone maintenance treatment, MMT) and anti retroviral therapy (Antiretroviral therapy ART) is an important means to improve HIV drug addicts living conditions. The existing scientific evidence shows that MMT can increase the HIV of drug addicts ART coverage and compliance, reduce the mortality rate. Chinese established national MMT and ART project, the results of two projects are evaluation, but evaluation of treatment effect with little report.
Objective to analyze the effect and influencing factors of HIV drug addicts receiving ART and MMT.
Methods HIV drug addicts as the research object, the establishment of two observational study cohort. In 29 outpatient treatment standards of antiviral therapy in 2011 (CD4350 / L) of all drug untreated HIV as the research object, the establishment of antiviral therapy on queue. The combined use of ART and MMT in 2011 63 outpatient methadone in all conform to the ART standard (CD4350 / L) patients as the research object, the establishment of methadone treatment cohort. The combined use of ART and MMT are also included in the two cohort. Prospective follow-up of 1 years, the mortality rate of antiviral treatment cohort, for the suppression of viral load power and influence factors analysis of mortality; cohort of methadone treatment rate, MMT rate of maintenance and analysis of related factors.
The results of antiviral therapy cohort a total of 1633 patients with HIV drug addicts, including 324 cases with MMT, 625 cases were still in use of drugs, 684 cases without the use of drugs. The entire cohort were followed up for 1 years, 80.3% out of 13.5% in the treatment, 6.2% died in group.MMT, without the use of drugs, drug use group of disease death rate respectively. 5.5,1.7,15.2/ hundred years. The influencing factors of death Cox regression model multivariate regression analysis: unemployed highest death risk of [AHR=23.5 (95%CI:3.3-170.4)]; other factors include the use of drugs [AHR=6.2 (95%CI:3.1-12.3) or MMT [AHR=2.7 (95% CI:1.2-6.0)], [the low level treatment mechanism: AHR=6.2 (95%CI:1.7-23.0), the AHR=4.9 (95%CI:1.3-17.9), male [AHR=2.2 (95%CI:1.1-4.5), hemoglobin 120g/l[AHR=2.2 (95%CI:1.4-3.3). CD4200 / L [AHR=2.1 (95%CI:1.3-3.4).
1070 cases of 1 years of viral load, plasma viral load suppression rate (400 copies /ml) which reached 83.6%., without the use of drugs was the suppression of viral load rate was 87.7%, MMT group and drug use group virus inhibition rates were the same, logistic 79.6%. multiple factors on patients with viral load suppression the failure of the regression analysis, unmarried or divorced [AOR=1.63 (95%CI:1.13-2.35)], no [AOR=1.64 (95%CI:1.05-2.56)], the minority [AOR=1.95 (95%CI:1.33-2.88)], the use of drugs [AOR=1.68 (95%CI:1.10-2.57) or MMT [AOR=1.65 (95%CI: 1.02-2.66)], the CDC outpatient treatment [AOR=2.53 (95%CI:1.30-4.94)] increased suppression of viral load failure risk.
Methadone treatment cohort of 509 patients including 324 patients with MMT and ART, and 185 patients did not receive ART patients. ART group of 1 years of follow-up, the total mortality rate was 5.5/ person years, ART group total mortality rate 7.4/ 100 years. The influencing factors of death of Cox proportional hazard model regression analysis: CD4200 [AHR=5.5 / L is the only influence factors of death (95%CI:2.2-13.9).
缇庢矙閰不鐤楅槦鍒楄瀵，
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