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JAIDS:HIV感染者新希望,抗逆转录病毒治疗

来源:生物谷    2014-10-16 09:03

近日旧金山加州大学新临床研究显示,与那些不使用兴奋剂的感染艾滋病毒的人相比,341名使用冰毒和可卡因的感染艾滋病毒的人通过抗逆转录病毒的方法治疗初步见效。

“艾滋病患者用抗逆转录病毒疗法常常遇到困难,部分原因由于医疗服务提供者的担忧,他们不能准确把握药物定向。来自本研究的发现表明,许多兴奋剂使用者能够准确把握抗逆转录病毒治疗方法,这样足以避免引起消极的临床后果。抗逆转录病毒疗法能引起一些较好的临床效益,包括兴奋剂使用者和非兴奋剂使用者。”Adam W. Carrico博士说。

在Multicenter AIDS Cohort Study研究中,1313名感染艾滋病病毒的男性通过男男性交而患病。“如果我们要实现国家艾滋病战略和联合国艾滋病规划署的结束艾滋病流行的目标,那么我们需要就是在为他们治疗艾滋病的同时鼓励他们停止或减少兴奋剂的使用。这样有效管理滥用兴奋剂与艾滋病的临床护理服务会改善病人状况并减少新发感染。”Carrico说。

旧金山总医院的艾滋病部门创造了一种综合服务递药系统,它可以作为其他诊所的模板。Carrico补充道。艾滋病初级保健诊所应用病人集中团队护理方法,对包括滥用兴奋剂和阿片类药物进行有效管理。

“真正的问题是,病人是否能按照规定使用抗逆转录病毒药物。我们发现在减少或停止兴奋剂使用之前,一些患者开始服用抗逆转录病毒药物,这样的临床效果非常好,这样的变化通常需要更复杂的行为、情感、人际关系和环境变化。”Valerie Gruber博士说。

Stimulant Use and Progression to AIDS or Mortality After The Initiation of Highly Active Anti-Retroviral Therapy

1.Adam W. Carrico, Steven Shoptaw, Christopher Cox, Ronald Stall, Xiuhong Li, David G. Ostrow, David Vlahov, Michael W. Plankey.

Background: HIV-positive persons who use stimulants (e.g., methamphetamine) experience profound health disparities, but it remains unclear if these persist after highly active anti-retroviral therapy (HAART) initiation. Conducted within the Multicenter AIDS Cohort Study, this investigation examined if stimulant use is associated with progression to AIDS or all-cause mortality after the initiation of HAART. Methods: Using marginal structural modeling, the cumulative proportion of visits where any stimulant use was reported (i.e., 0%, 1-49%, 50-99%, and 100%) was examined as a time-varying predictor of: 1) all-cause mortality; and 2) AIDS or all-cause mortality. Results: Among the 1,313 men who have sex with men (MSM) who initiated HAART, findings showed no significant association of any level of stimulant use with all-cause mortality. A competing risks analysis indicated that no level of stimulant use was associated with increased AIDS-related or non-AIDS mortality separately. Among the 648 participants without AIDS at HAART initiation, a secondary analysis indicated that stimulant use at 50% or more of study visits was associated with a 1.5-fold increase in the odds of progression to AIDS or all-cause mortality (Adjusted OR = 1.54; 95% CI = 1.02 - 2.33, p < .05). Conclusions: HIV-positive, stimulant-using MSM receiving HAART appear to face no greater overall risks for all-cause, AIDS-related, or non-AIDS mortality compared to non-users. However, men without AIDS at HAART initiation who more frequently reported stimulant use demonstrated modestly increased odds of progression to AIDS or all-cause mortality. Comprehensive approaches are needed to optimize the effectiveness of HAART with stimulant-using MSM.