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首页 » Clin Infect Dis:吸烟对于HIV感染者来说比HIV本身更致命

Clin Infect Dis:吸烟对于HIV感染者来说比HIV本身更致命

来源:互联网 2012-12-26 00:48

大多数的人类免疫缺陷病毒(HIV)感染者可以通过高效抗逆转录病毒疗法(HAART)使病情得到有效控制。因此,对于后HAART治疗地区来说,与生活方式相关的因素或许会比HIV本身对HIV感染者的长期生存造成更大的威胁。在普通人群中,吸烟是造成预期寿命减少的最重要因素,但吸烟本身也是一个可预防的因素。基于上述情况,来自丹麦哥本哈根大学医院感染病科的医学博士Marie Helleberg等人展开一项研究,研究结果在线发表在2012年12月18日的《临床感染性疾病》(Clincal Infectious Diseases)杂志上。作者发现,对于HIV患者来说,吸烟比HIV感染更致命。

本研究的目的是评估感染HIV人群由于吸烟而导致死亡的情况。这是丹麦的一项基于人群的全国性队列研究,于1995-2010年期间开展,研究对象包括HIV队列和与之相匹配的HIV阴性队列。研究人员评估了这两个队列人群中的现时吸烟者和非吸烟者与吸烟相关或是与HIV感染相关的死亡率(MRs)、死亡率比(MRRs)、预期寿命、寿命年的损失和人群死亡归因风险。

本研究共纳入了2921例HIV患者和10 642例对照,随访人年数分别为14 281人年和45 122人年。研究结果如下,在HIV患者中,与不吸烟患者相比,吸烟患者的全因死亡率和非AIDS(获得性免疫缺陷综合症)相关死亡率均大幅增加(MRR=4.4,[95%置信区间{CI}:3.0-6.7];MRR=5.3,[95%CI:3.2-8.8])。对于HIV患者组,现时吸烟者与不吸烟者相比,每1000人年的额外死亡率为17.6(95%CI:13.3-21.9),而对照组则为4.8/1000人年(95%CI:3.2-6.4)。对于35岁的HIV患者来说,吸烟者的预期寿命中位数为62.6岁(95%CI:59.9-64.6),而非吸烟者则为78.4岁(95%CI:70.8-84.0);与吸烟或者HIV相关的寿命年损失分别为12.3(95%CI:8.1-16.4)和5.1(95%CI:1.6-8.5)。与吸烟相关的人群死亡归因风险在HIV患者组为61.5%,在对照组则为34.2%。

研究发现,在那些HIV护理能够得到有效组织且提供免费抗逆转录病毒治疗的地区,感染HIV的吸烟者由于吸烟损失的寿命年要比由于HIV损失的多,即对于HIV患者来说,吸烟比HIV感染更致命。对于HIV患者,吸烟者的额外死亡率为对照人群的3倍,与吸烟相关的人群死亡归因风险为对照人群的2倍。(生物谷Bioon.com)

Mortality Attributable to Smoking Among HIV-1–Infected Individuals: A Nationwide, Population-Based Cohort Study

Marie Helleberg1,7, Shoaib Afzal2, Gitte Kronborg3, Carsten S. Larsen4, Gitte Pedersen5, Court Pedersen6, Jan Gerstoft1, Børge G. Nordestgaard2,7, and Niels Obel1

Background. We assessed mortality attributable to smoking among patients with human immunodeficiency virus (HIV). Methods. We estimated mortality rates (MRs), mortality rate ratios (MRRs), life expectancies, life-years lost, and population-attributable risk of death associated with smoking and with HIV among current and nonsmoking individuals from a population-based, nationwide HIV cohort and a cohort of matched HIV-negative individuals. Results. A total of 2921 HIV patients and 10 642 controls were followed for 14 281 and 45 122 person-years, respectively. All-cause and non-AIDS-related mortality was substantially increased among smoking compared to nonsmoking HIV patients (MRR, 4.4 [95% confidence interval {CI}, 3.0–6.7] and 5.3 [95% CI, 3.2–8.8], respectively). Excess MR per 1000 person-years among current vs nonsmokers was 17.6 (95% CI, 13.3–21.9) for HIV patients and 4.8 (95% CI, 3.2–6.4) for controls. A 35-year-old HIV patient had a median life expectancy of 62.6 years (95% CI, 59.9–64.6) for smokers and 78.4 years (95% CI, 70.8–84.0) for nonsmokers; the numbers of life-years lost in association with smoking and HIV were 12.3 (95% CI, 8.1–16.4) and 5.1 (95% CI, 1.6–8.5). The population-attributable risk of death associated with smoking was 61.5% among HIV patients and 34.2% among controls. Conclusions. In a setting where HIV care is well organized and antiretroviral therapy is free of charge, HIV-infected smokers lose more life-years to smoking than to HIV. The excess mortality of smokers is tripled and the population-attributable risk of death associated with smoking is doubled among HIV patients compared to the background population.

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