Lohse Nicolai, Hansen Ann-Brit Eg, Gerstoft Jan, Obel Niels
Department of Clinical Epidemiology, Arhus University Hospital, DK-8000 Arhus C, Denmark.
J Antimicrob Chemother. 2007 Sep;60(3):461-3. doi: 10.1093/jac/dkm241. Epub 2007 Jul 2.
A human immunodeficiency virus (HIV) patient in 2007 has the option to commence an antiretroviral regimen that is extremely efficacious in suppressing the virus and has few side effects. In a recent study, we estimated the median remaining lifetime of a newly diagnosed 25-year-old HIV-infected individual to be 39 years. The prospect of a near-normal life expectancy has implications for the HIV-infected persons as well as for the handling of the disease in the healthcare system. The patients can now on a long-term perspective plan their professional career, join a pension plan and start a family. Further, they may expect to be treated equally with other members of society with respect to access to mortgage, health insurance and life insurance. As the infected population ages, more patients will contract age-related diseases, and the disease burden on some individuals may even come to be dominated by non-HIV-related conditions that may have a worse prognosis and therefore become more important than HIV-related conditions. Despite the improvements in antiretroviral therapy, there is still an excess mortality among HIV patients, which appears to be only partially attributable to immunodeficiency, with lifestyle factors potentially playing a pronounced role. Consequently, an effort to further increase survival must target risk factors for both HIV-related and -unrelated mortality. The continuation of the positive trend may be achieved by increased HIV testing, earlier initiation of antiretroviral therapy, improved drug adherence, prevention and treatment of HIV-unrelated co-morbidity and collaboration with other medical specialists to treat an ageing co-morbidity-acquiring HIV population.
对于2007年的一名人类免疫缺陷病毒（HIV）患者来说，可以选择开始一种抗逆转录病毒疗法，这种疗法在抑制病毒方面极其有效且副作用很少。在最近的一项研究中，我们估计一名新诊断出感染HIV的25岁个体的剩余寿命中位数为39年。接近正常预期寿命的前景对HIV感染者以及医疗系统中该疾病的处理都有影响。从长远来看，患者现在可以规划他们的职业生涯、加入养老金计划并组建家庭。此外，他们可能期望在获得抵押贷款、健康保险和人寿保险方面能与社会其他成员受到平等对待。随着感染人群的老龄化，更多患者会患上与年龄相关的疾病，而且某些个体的疾病负担甚至可能由非HIV相关疾病主导，这些疾病的预后可能更差，因此可能比HIV相关疾病更为重要。尽管抗逆转录病毒疗法有所改进，但HIV患者中仍存在额外的死亡率，这似乎仅部分归因于免疫缺陷，生活方式因素可能起着显著作用。因此，要进一步提高生存率，必须针对与HIV相关和不相关死亡率的危险因素。通过增加HIV检测、更早开始抗逆转录病毒治疗、提高药物依从性、预防和治疗与HIV无关的合并症以及与其他医学专家合作来治疗日益老龄化且患有合并症的HIV人群，可能会延续这一积极趋势。
