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Optimizing treatment outcomes in HIV-infected drug users: An epidemiological assessment and interventional model.

机译：优化感染HIV的吸毒者的治疗效果：一种流行病学评估和干预模型。

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摘要

Individuals with a history of injection drug use account for 31% of AIDS cases in the United States and up to half of those treated in many urban settings. This dissertation comprises a series of epidemiologic studies on the relationship between drug use and HIV treatment outcomes in the Johns Hopkins Clinical Cohort, and the development and pilot assessment of an interventional strategy, directly administered antiretroviral therapy (DAART). First, in a cross-sectional analysis of 764 treatment-eligible HIV-infected participants who completed a confidential survey, we found that active drug users were less likely to have used combination antiretroviral therapy, had lower self-reported adherence, smaller decreases in HIV RNA levels, and smaller increases in CD4+ cell counts than non-drug users. Conversely, former drug users and non-drug users were quite similar in utilization of and adherence with therapy, and in measures of treatment effectiveness. Second, in a longitudinal analysis of 695 treatment-eligible participants, who completed at least two confidential surveys at 6-month intervals, transitions from non-use to use of drugs were associated with worsening utilization of antiretroviral therapy, virologic status, and immunologic status, compared to those who remained non-users in consecutive surveys. In contrast, transitions from use to non-use of drugs were associated with improvements in all HIV treatment outcomes, compared to those who remained users in consecutive surveys. Finally, 50 participants were enrolled in a pilot study of DAART in a methadone treatment facility, located near the Johns Hopkins HIV Clinic. In a non-randomized cohort comparison study, the proportion of DAART participants who achieved viral suppression at 6 months was significantly higher than the proportions achieving viral suppression in two frequency-matched randomly-selected comparison groups from the Johns Hopkins HIV Clinical Cohort: drug users currently in methadone treatment, and non-drug users. This research highlights the close temporal relationship between changes in drug user status and HIV treatment outcomes, and provides the rationale for the further development and assessment of treatment models that integrate HIV care and substance abuse treatment.
机译：在美国，有注射吸毒史的人占艾滋病病例的31％，在许多城市环境中，高达一半。本论文包括一系列关于约翰斯·霍普金斯临床队列中药物使用与HIV治疗结局之间关系的流行病学研究，以及直接进行抗逆转录病毒治疗（DAART）的干预策略的开发和试点评估。首先，在对完成秘密调查的764名符合治疗资格的HIV感染者的横断面分析中，我们发现，积极吸毒者不太可能使用抗逆转录病毒疗法联合治疗，自我报告的依从性较低，HIV的下降幅度较小RNA水平和CD4 +细胞计数的增加要比非毒品使用者小。相反，以前的吸毒者和非吸毒者在治疗的利用和依从性以及治疗效果的衡量上都非常相似。其次，在对695名符合治疗要求的参与者进行的纵向分析中，他们至少每隔6个月完成两次秘密调查，从不使用药物过渡到使用药物与抗逆转录病毒疗法的利用率，病毒学状况和免疫学状况恶化有关，与连续调查中仍不使用的用户相比。相反，与那些在连续调查中仍然使用毒品的人相比，从使用毒品到不使用毒品的转变与所有HIV治疗结果的改善有关。最后，有50名参与者参加了在约翰·霍普金斯（Johns Hopkins）HIV诊所附近的美沙酮治疗设施中进行DAART的试验研究。在一项非随机队列比较研究中，在六个月时获得病毒抑制的DAART参与者的比例显着高于在约翰霍普金斯HIV临床队列的两个频率匹配的随机选择的对照组中达到病毒抑制的比例：吸毒者目前正在美沙酮治疗中，并且是非毒品使用者。这项研究突出了吸毒者状况变化与HIV治疗结果之间的紧密时间关系，并为进一步开发和评估将HIV护理与药物滥用治疗相结合的治疗模型提供了依据。

著录项

  • 作者

    Lucas, Gregory M.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2004
  • 页码 100 p.
  • 总页数 100
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;
  • 关键词

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