HIV 感染者的发病率和老龄化：瑞士 HIV 队列研究。

Morbidity and aging in HIV-infected persons: the Swiss HIV cohort study.

机构信息

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.

出版信息

Clin Infect Dis. 2011 Dec;53(11):1130-9. doi: 10.1093/cid/cir626. Epub 2011 Oct 13.

DOI:10.1093/cid/cir626

PMID:21998280

Abstract

BACKGROUND

Patterns of morbidity and mortality among human immunodeficiency virus (HIV)-infected individuals taking antiretroviral therapy are changing as a result of immune reconstitution and improved survival. We studied the influence of aging on the epidemiology of non-AIDS diseases in the Swiss HIV Cohort Study.

METHODS

The Swiss HIV Cohort Study is a prospective observational cohort established in 1988 with continuous enrollment. We determined the incidence of clinical events (per 1000 person-years) from January 2008 (when a new questionnaire on non-AIDS-related morbidity was introduced) through December 2010. Differences across age groups were analyzed using Cox regression, adjusted for CD4 cell count, viral load, sex, injection drug use, smoking, and years of HIV infection.

RESULTS

Overall, 8444 (96%) of 8848 participants contributed data from 40,720 semiannual visits; 2233 individuals (26.4%) were aged 50-64 years, and 450 (5.3%) were aged ≥65 years. The median duration of HIV infection was 15.4 years (95% confidence interval [CI], 9.59-22.0 years); 23.2% had prior clinical AIDS. We observed 994 incident non-AIDS events in the reference period: 201 cases of bacterial pneumonia, 55 myocardial infarctions, 39 strokes, 70 cases of diabetes mellitus, 123 trauma-associated fractures, 37 fractures without adequate trauma, and 115 non-AIDS malignancies. Multivariable hazard ratios for stroke (17.7; CI, 7.06-44.5), myocardial infarction (5.89; 95% CI, 2.17-16.0), diabetes mellitus (3.75; 95% CI, 1.80-7.85), bone fractures without adequate trauma (10.5; 95% CI, 3.58-30.5), osteoporosis (9.13; 95% CI, 4.10-20.3), and non-AIDS-defining malignancies (6.88; 95% CI, 3.89-12.2) were elevated for persons aged ≥65 years.

CONCLUSIONS

Comorbidity and multimorbidity because of non-AIDS diseases, particularly diabetes mellitus, cardiovascular disease, non-AIDS-defining malignancies, and osteoporosis, become more important in care of HIV-infected persons and increase with older age.

摘要

背景

随着免疫重建和生存状况的改善，接受抗逆转录病毒治疗的艾滋病毒（HIV）感染者的发病率和死亡率模式正在发生变化。我们研究了衰老对瑞士艾滋病毒队列研究中非艾滋病疾病流行病学的影响。

方法

瑞士艾滋病毒队列研究是 1988 年建立的一项前瞻性观察队列，持续招募。我们从 2008 年 1 月（当时引入了一份新的非艾滋病相关发病率调查问卷）至 2010 年 12 月，确定了临床事件的发病率（每 1000 人年）。使用 Cox 回归分析了不同年龄组之间的差异，调整了 CD4 细胞计数、病毒载量、性别、注射吸毒、吸烟和 HIV 感染年限。

结果

共有 8848 名参与者中的 8444 名（96%）提供了 40720 次半年一次的就诊数据；2233 名（26.4%）参与者年龄在 50-64 岁之间，450 名（5.3%）参与者年龄≥65 岁。HIV 感染的中位时间为 15.4 年（95%置信区间[CI]，9.59-22.0 年）；23.2%的人曾患有临床艾滋病。在参考期内，我们观察到了 994 例非艾滋病事件：201 例细菌性肺炎、55 例心肌梗死、39 例中风、70 例糖尿病、123 例创伤相关骨折、37 例无充分创伤的骨折和 115 例非艾滋病恶性肿瘤。多变量风险比为：中风（17.7；CI，7.06-44.5）、心肌梗死（5.89；CI，2.17-16.0）、糖尿病（3.75；CI，1.80-7.85）、无充分创伤的骨折（10.5；CI，3.58-30.5）、骨质疏松症（9.13；CI，4.10-20.3）和非艾滋病定义的恶性肿瘤（6.88；CI，3.89-12.2）年龄≥65 岁的患者升高。