身体机能与HIV疾病及死亡率的关系。
The relationship of physical performance with HIV disease and mortality.
作者信息
Greene Meredith, Covinsky Kenneth, Astemborski Jacquie, Piggott Damani A, Brown Todd, Leng Sean, Galai Noya, Mehta Shruti H, Guralnik Jack, Patel Kushang V, Kirk Gregory D
机构信息
aDivision of Geriatrics, Department of Medicine, University of California San Francisco bSan Francisco Veterans Affairs Medical Center, San Francisco, California cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health dDivision of Infectious Diseases eDivision of Endocrinology and Metabolism fDivision of Geriatrics and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA gDepartment of Statistics, University of Haifa, Mt Carmel, Israel hDepartment of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland iDepartment of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA.
出版信息
AIDS. 2014 Nov 28;28(18):2711-9. doi: 10.1097/QAD.0000000000000507.
OBJECTIVE
To evaluate whether HIV infection was associated with reduced physical performance, and to examine if reduced physical performance predicted mortality in our aging cohort of HIV-infected and HIV-uninfected persons.
DESIGN
Prospective, observational cohort of current and former injection drug users in the AIDS Linked to the IntraVenous Experience study in Baltimore, Maryland, USA.
METHODS
The Short Physical Performance Battery (SPPB) was used as an objective measure of physical performance and measured semiannually along with behavioral and demographic data. Correlates of reduced physical performance (SPPB score ≤10) were identified and the relationship between reduced physical performance, HIV infection and mortality was analyzed by Cox regression.
RESULTS
Among 12 270 person-visits contributed by 1627 participants, the median age was 51, 30.3% were HIV-infected and 32.6% had an SPPB score 10 or less. In multivariable models, HIV infection was independently associated with 30% increased odds of reduced physical performance [odds ratio 1.30; 95% confidence interval (CI):1.12-1.52]. Reduced physical performance predicted mortality in a dose-response manner and within all HIV disease strata. Whereas reduced physical performance alone (hazard ratio 2.52, 95% CI: 1.59-4.00) and HIV infection alone (hazard ratio 2.78, 95% CI: 1.70-4.54) increased mortality, HIV-infected participants with reduced physical performance had a six-fold increased mortality risk (hazard ratio 6.03, 95% CI: 3.80-10.0) compared with HIV-uninfected participants with higher physical performance.
CONCLUSION
HIV infection was independently associated with reduced physical performance. HIV and reduced physical performance have independent and joint effects on mortality. Physical performance measurement may be an important research and clinical tool to predict adverse outcomes among aging HIV-infected persons.
目的
评估HIV感染是否与身体机能下降有关，并检验身体机能下降是否可预测美国马里兰州巴尔的摩市艾滋病与静脉注射经历研究中感染HIV和未感染HIV的老年队列人群的死亡率。
设计
对美国马里兰州巴尔的摩市艾滋病与静脉注射经历研究中现有的和曾经的注射吸毒者进行前瞻性观察队列研究。
方法
采用简短身体机能测试量表（SPPB）作为身体机能的客观测量指标，并每半年测量一次，同时收集行为和人口统计学数据。确定身体机能下降（SPPB评分≤10）的相关因素，并通过Cox回归分析身体机能下降、HIV感染与死亡率之间的关系。
结果
在1627名参与者贡献的12270人次访视中，中位年龄为51岁，30.3%的人感染了HIV，32.6%的人SPPB评分为10分或更低。在多变量模型中，HIV感染与身体机能下降几率增加30%独立相关[比值比1.30；95%置信区间（CI）：1.12 - 1.52]。身体机能下降以剂量反应方式预测死亡率，且在所有HIV疾病分层中均如此。单独身体机能下降（风险比2.52，95%CI：1.59 - 4.00）和单独HIV感染（风险比2.78，95%CI：1.70 - 4.54）均会增加死亡率，但与身体机能较高的未感染HIV参与者相比，身体机能下降的感染HIV参与者的死亡风险增加了六倍（风险比6.03，95%CI：3.80 - 10.0）。
结论
HIV感染与身体机能下降独立相关。HIV和身体机能下降对死亡率具有独立和联合影响。身体机能测量可能是预测老年HIV感染者不良结局的重要研究和临床工具。
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