Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Lancet HIV. 2015 Jul;2(7):e288-98. doi: 10.1016/S2352-3018(15)00077-6. Epub 2015 May 27.
Whether the reported high risk of age-related diseases in HIV-infected people is caused by biological ageing or HIV-associated risk factors such as chronic immune activation and low-grade inflammation is unknown. We assessed time trends in age-standardised and relative risks of nine serious age-related diseases in a nationwide cohort study of HIV-infected individuals and population controls.
We identified all HIV-infected individuals in the Danish HIV Cohort Study who had received HIV care in Denmark between Jan 1, 1995, and June 1, 2014. Population controls were identified from the Danish Civil Registration System and individually matched in a ratio of nine to one to the HIV-infected individuals for year of birth, sex, and date of study inclusion. Individuals were included in the study if they had a Danish personal identification number, were aged 16 years or older, and were living in Denmark at the time of study inclusion. Data for study outcomes were obtained from the Danish National Hospital Registry and the Danish National Registry of Causes of Death and were cardiovascular diseases (myocardial infarction and stroke), cancers (virus associated, smoking related, and other), severe neurocognitive disease, chronic kidney disease, chronic liver disease, and osteoporotic fractures. We calculated excess and age-standardised incidence rates and adjusted incidence rate ratios of outcomes for time after HIV diagnosis, highly active antiretroviral therapy (ART) initiation, and calendar time. The regression analyses were adjusted for age, sex, calendar time, and origin.
We identified 5897 HIV-infected individuals and 53,073 population controls; median age was 36·8 years (IQR 30·6-44·4), and 76% were men in both cohorts. Dependent on disease, the HIV cohort had 55,050-57,631 person-years of follow-up and the population controls had 638,204-659,237 person-years of follow-up. Compared with the population controls, people with HIV had high excess and relative risk of all age-related diseases except other cancers. Overall, the age-standardised and relative risks of cardiovascular diseases, cancers, and severe neurocognitive disease did not increase substantially with time after HIV diagnosis or ART initiation. Except for chronic kidney diseases, the age-standardised and relative risks of age-related diseases did not increase with calendar time.
Severe age-related diseases are highly prevalent in people with HIV, and continued attention and strategies for risk reduction are needed. The findings from our study do not suggest that accelerated ageing is a major problem in the HIV-infected population.
Preben og Anna Simonsens Fond, Novo Nordisk Foundation, Danish AIDS Foundation, Augustinus Foundation, and Odense University Hospitals Frie Fonds Midler.
HIV 感染者报告的与年龄相关疾病的高风险是由生物衰老引起，还是由慢性免疫激活和低度炎症等 HIV 相关危险因素引起，尚不清楚。我们在一项针对 HIV 感染者的全国性队列研究和人群对照中，评估了年龄标准化和九种严重与年龄相关疾病的相对风险的时间趋势。
我们在丹麦 HIV 队列研究中确定了所有在 1995 年 1 月 1 日至 2014 年 6 月 1 日期间在丹麦接受 HIV 护理的 HIV 感染者。人群对照是从丹麦民事登记系统中确定的，并按 9:1 的比例与 HIV 感染者按出生年份、性别和研究纳入日期进行一对一匹配。如果个体有丹麦个人身份号码、年龄在 16 岁或以上并且在研究纳入时居住在丹麦，则将其纳入研究。研究结果的数据来自丹麦国家医院登记处和丹麦国家死因登记处，包括心血管疾病（心肌梗死和中风）、癌症（病毒相关、吸烟相关和其他）、严重神经认知疾病、慢性肾脏病、慢性肝病和骨质疏松性骨折。我们计算了 HIV 诊断后、高效抗逆转录病毒治疗（ART）开始后和日历时间的结果的超额和年龄标准化发病率以及调整发病率比。回归分析调整了年龄、性别、日历时间和来源。
我们确定了 5897 名 HIV 感染者和 53073 名人群对照；中位年龄为 36.8 岁（IQR 30.6-44.4），两个队列中均有 76%为男性。取决于疾病，HIV 队列的随访时间为 55050-57631 人年，人群对照的随访时间为 638204-659237 人年。与人群对照相比，HIV 感染者的所有与年龄相关的疾病都有较高的超额和相对风险，除了其他癌症。总体而言，心血管疾病、癌症和严重神经认知疾病的年龄标准化和相对风险在 HIV 诊断或 ART 开始后并没有显著增加。除慢性肾脏病外，与年龄相关疾病的年龄标准化和相对风险并没有随日历时间的增加而增加。
HIV 感染者严重的与年龄相关疾病的发病率很高，需要继续关注并采取降低风险的策略。我们的研究结果表明，HIV 感染者的加速衰老并不是一个主要问题。
Preben 和 Anna Simonsens 基金会、诺和诺德基金会、丹麦艾滋病基金会、Augustinus 基金会和欧登塞大学医院 Frie 基金会。
