Department of Clinical Epidemiology, Århus University Hospital, Århus, Denmark.
J Acquir Immune Defic Syndr. 2011 Aug 1;57(4):334-9. doi: 10.1097/QAI.0b013e31821d34ed.
We aimed to estimate the impact of comorbidity acquired before HIV diagnosis on mortality in individuals infected with HIV.
This cohort study compared 2 different cohorts. The prospective population-based nationwide observational Danish HIV Cohort Study was used to compare all adults diagnosed with HIV in Denmark from 1997 with a matched general population cohort. Comorbidity history was ascertained from the Danish National Patient Registry and vital statistics obtained from the Danish Civil Registration System. Cox regression was used to estimate the impact of Charlson comorbidity index (CCI) and hepatitis C virus coinfection on mortality, and population attributable risk was used to assess the proportional impact of comorbidity on mortality.
CCI comorbidity was present before HIV diagnosis in 11.3% of 1638 persons with HIV, and in 8.0% of 156,506 persons in the general population. The risk for death in patients with HIV with at least 1 CCI point was 1.84 times higher than in those with no CCI points (adjusted mortality rate ratio, 95% confidence interval: 1.32 to 2.57). The annual risk of dying for patients with HIV vs general population with 0, 1, 2, and 3+ CCI points was 1.70% (1.44 to 2.00) vs 0.27% (0.26 to 0.28), 4.37% (3.01 to 6.32) vs 1.36% (1.26 to 1.47), 8.06% (4.94 to 13.16) vs 2.44% (2.22 to 2.68), and 10.15% (5.08 to 20.30) vs 5.84% (5.19 to 6.58), respectively. Comorbidity acquired before HIV, hepatitis C virus coinfection, and background mortality accounted for 45% of total mortality in the population infected with HIV.
Almost half of deaths in persons diagnosed with HIV in a health care setting with free access to highly active antiretroviral therapy stemmed from factors unrelated to HIV disease.
本研究旨在评估艾滋病毒感染患者在诊断前获得的合并症对死亡率的影响。
本队列研究比较了两个不同的队列。前瞻性基于人群的丹麦全国性观察性 HIV 队列研究用于比较 1997 年在丹麦诊断出的所有艾滋病毒感染者和匹配的一般人群队列。合并症病史来自丹麦国家患者登记处，生命统计数据来自丹麦民事登记系统。Cox 回归用于估计 Charlson 合并症指数（CCI）和丙型肝炎病毒合并感染对死亡率的影响，人群归因风险用于评估合并症对死亡率的比例影响。
在 1638 名 HIV 患者中，11.3%的患者在 HIV 诊断前存在 CCI 合并症，在 156506 名一般人群中，8.0%的患者存在 CCI 合并症。至少有 1 个 CCI 点的 HIV 患者死亡风险是没有 CCI 点的患者的 1.84 倍（调整后的死亡率比，95%置信区间：1.32 至 2.57）。与一般人群相比，HIV 患者的年死亡率为 0、1、2 和 3+CCI 点分别为 1.70%（1.44 至 2.00）、0.27%（0.26 至 0.28）、4.37%（3.01 至 6.32）、1.36%（1.26 至 1.47）、8.06%（4.94 至 13.16）和 2.44%（2.22 至 2.68）、10.15%（5.08 至 20.30）和 5.84%（5.19 至 6.58）。在获得 HIV 之前获得的合并症、丙型肝炎病毒合并感染和背景死亡率占感染 HIV 人群总死亡率的 45%。
在获得免费高效抗逆转录病毒治疗的卫生保健环境中诊断出的 HIV 患者中，近一半的死亡归因于与 HIV 疾病无关的因素。
