HIV 感染者与普通人群相比，过早出现与年龄相关的共病。

Premature age-related comorbidities among HIV-infected persons compared with the general population.

机构信息

Department of Medicine and Medical Specialities, University of Modena and Reggio Emilia, Italy.

出版信息

Clin Infect Dis. 2011 Dec;53(11):1120-6. doi: 10.1093/cid/cir627. Epub 2011 Oct 13.

DOI:10.1093/cid/cir627

PMID:21998278

Abstract

BACKGROUND

Human immunodeficiency virus (HIV)-infected patients may have a greater risk of noninfectious comorbidities (NICMs) compared with the general population. We assessed the prevalence and risk factors for NICMs in a large cohort of HIV-infected adults and compared these findings with data from matched control subjects.

METHODS

We performed a case-control study involving antiretroviral therapy (ART)-experienced HIV-infected patients treated at Modena University, Italy, from 2002 through 2009. These patients were compared with age-, sex-, and race-matched adults (control subjects) from the general population included in the CINECA ARNO database. NICMs included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Polypathology (Pp) was defined as the concurrent presence of ≥2 NICMs. Logistic regression models were constructed to evaluate associated predictors of NICMs and Pp.

RESULTS

There were 2854 patients and 8562 control subjects. The mean age was 46 years, and 37% were women. Individual NICM and Pp prevalences in each age stratum were higher among patients than among controls (all P <.001). Pp prevalence among patients aged 41-50 years was similar to that among controls aged 51-60 years (P value was not statistically significant); diabetes mellitus, cardiovascular disease, bone fractures, and renal failure were statistically independent after adjustment for sex, age, and hypertension. Logistic regression models showed that independent predictors of Pp in the overall cohort were (all P < .001) age (odds ratio [OR], 1.11), male sex (OR, 1.77), nadir CD4 cell count <200 cells/μL (OR, 4.46), and ART exposure (OR, 1.01).

CONCLUSIONS

Specific age-related NICMs and Pp were more common among HIV-infected patients than in the general population. The prevalence of Pp in HIV-infected persons anticipated Pp prevalence observed in the general population among persons who were 10 years older, and HIV-specific cofactors (lower nadir CD4 cell count and more prolonged ART exposure) were identified as risk factors. These data support the need for earlier screening for NICMs in HIV-infected patients.

摘要

背景

与普通人群相比，人类免疫缺陷病毒（HIV）感染者可能面临更大的非传染性合并症（NICMs）风险。我们评估了意大利摩德纳大学 2002 年至 2009 年期间接受抗逆转录病毒治疗（ART）的大量 HIV 感染成年患者的 NICMs 患病率和危险因素，并将这些发现与来自 CINECA ARNO 数据库的普通人群中匹配对照者的数据进行了比较。NICMs 包括心血管疾病、高血压、糖尿病、骨折和肾衰竭。多系统疾病（Pp）定义为同时存在≥2 种 NICMs。构建了逻辑回归模型来评估 NICMs 和 Pp 的相关预测因素。

方法

我们进行了一项病例对照研究，纳入了意大利摩德纳大学 2002 年至 2009 年接受抗逆转录病毒治疗的 HIV 感染成年患者（病例组），并与来自 CINECA ARNO 数据库的普通人群中年龄、性别和种族匹配的成年人（对照组）进行比较。NICMs 包括心血管疾病、高血压、糖尿病、骨折和肾衰竭。多系统疾病（Pp）定义为同时存在≥2 种 NICMs。构建了逻辑回归模型来评估 NICMs 和 Pp 的相关预测因素。

结果

共纳入 2854 名患者和 8562 名对照者。平均年龄为 46 岁，37%为女性。各年龄段患者的个体 NICM 和 Pp 患病率均高于对照者（均 P<0.001）。41-50 岁患者的 Pp 患病率与 51-60 岁对照者相似（P 值无统计学意义）；校正性别、年龄和高血压后，糖尿病、心血管疾病、骨折和肾衰竭仍为独立的预测因素。全队列逻辑回归模型显示，Pp 的独立预测因素为（均 P<0.001）年龄（比值比[OR]，1.11）、男性（OR，1.77）、最低 CD4 细胞计数<200 个/μL（OR，4.46）和 ART 暴露（OR，1.01）。

结论

与普通人群相比，HIV 感染者中更常见特定与年龄相关的 NICMs 和 Pp。HIV 感染者的 Pp 患病率预计将比 10 岁以上人群的普通人群中的 Pp 患病率更高，并且发现 HIV 特异性共病因素（更低的最低 CD4 细胞计数和更长的 ART 暴露）是危险因素。这些数据支持对 HIV 感染者进行更早的 NICMs 筛查。