Rising mortality among people who inject drugs living with HIV in Scotland, UK: A 20-year retrospective cohort study.

IF 2.8 3区医学 Q2 INFECTIOUS DISEASES

HIV Medicine Pub Date : 2024-11-18 DOI:10.1111/hiv.13733

R Metcalfe, R Fraser, K M A Trayner, M Glancy, A Yeung, L Sills, T Ritchie, S Priyadarshi, S E Peters, A McAuley, S Hutchinson

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引用次数: 0

Abstract

Objectives: Our aim was to examine mortality trends in the era of antiretroviral therapy, among people who inject drugs (PWID) who are living with HIV. The study objectives were to assess and quantify mortality among PWID diagnosed with HIV over time in Scotland, in the context of a recent outbreak of HIV and rise in drug-related mortality.

Methods: This was a retrospective cohort study of those diagnosed with HIV in Scotland between January 2000 and February 2020, with acquisition related to injecting drug use, linked to mortality data. Factors associated with all-cause mortality were examined using Cox proportional hazards regression.

Results: Among 430 individuals with 3143 person-years (py) of follow-up, 88 (20.5%) died. Drug-related deaths accounted for 45.5% of all deaths, rising to 60% among those diagnosed in 2015-2020. The crude all-cause mortality was 28.00 per 1000 py overall and 37.62 per 1000 py within 5 years of diagnosis. Mortality risk was markedly higher among PWID diagnosed in 2015-2020 [adjusted hazard ratio (aHR) = 3.53], relative to those diagnosed in 2000-2004. Among those diagnosed in 2015-2020 (as part of the HIV outbreak), the mortality risk was higher among those not on, compared with those on, opioid agonist therapy (aHR = 3.87).

Conclusion: Mortality among PWID living with HIV in Scotland has risen substantially in the 21st century. Our findings highlight the important role of opioid-agonist therapy, alongside other prevention and treatment measures to address high levels of drug-related mortality for PWID living with HIV, including within HIV outbreaks in this population group.

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英国苏格兰注射毒品的艾滋病病毒感染者死亡率上升：一项为期 20 年的回顾性队列研究。

目标：我们的目的是研究在抗逆转录病毒疗法时代，注射吸毒者（PWID）艾滋病毒感染者的死亡率趋势。研究目标是评估和量化苏格兰注射吸毒者中确诊感染艾滋病病毒后一段时间内的死亡率，同时考虑到最近艾滋病病毒的爆发和与毒品有关的死亡率的上升：这是一项回顾性队列研究，研究对象是 2000 年 1 月至 2020 年 2 月期间苏格兰确诊的艾滋病毒感染者，其感染与注射吸毒有关，并与死亡率数据相关联。研究采用 Cox 比例危险回归法检测了与全因死亡率相关的因素：在随访了3143人年（py）的430人中，有88人（20.5%）死亡。在所有死亡病例中，与药物相关的死亡占 45.5%，在 2015-2020 年确诊的病例中，与药物相关的死亡占 60%。总的粗略全因死亡率为 28.00‰，确诊后 5 年内的粗略全因死亡率为 37.62‰。与 2000-2004 年确诊的感染者相比，2015-2020 年确诊的感染者的死亡风险明显更高[调整后危险比 (aHR) = 3.53]。在 2015-2020 年（作为艾滋病毒爆发的一部分）确诊的感染者中，未接受阿片类受体激动剂治疗者的死亡风险高于接受阿片类受体激动剂治疗者（aHR = 3.87）：结论：21 世纪以来，苏格兰感染艾滋病毒的吸毒者死亡率大幅上升。我们的研究结果凸显了阿片类受体激动剂疗法以及其他预防和治疗措施的重要作用，以解决感染艾滋病毒的吸毒者与毒品相关的高死亡率问题，包括在这一人群中爆发艾滋病毒疫情时。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

HIV Medicine 医学-传染病学

CiteScore

5.10

自引率

10.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： HIV Medicine aims to provide an alternative outlet for publication of international research papers in the field of HIV Medicine, embracing clinical, pharmocological, epidemiological, ethical, preclinical and in vitro studies. In addition, the journal will commission reviews and other feature articles. It will focus on evidence-based medicine as the mainstay of successful management of HIV and AIDS. The journal is specifically aimed at researchers and clinicians with responsibility for treating HIV seropositive patients.