美国军事HIV自然史研究中HIV控制者和HIV得到医学控制者的住院情况。
Hospitalizations among HIV controllers and persons with medically controlled HIV in the U.S. Military HIV Natural History Study.
作者信息
Crowell Trevor A, Ganesan Anuradha, Berry Stephen A, Deiss Robert G, Agan Brian K, Okulicz Jason F
机构信息
U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA;
出版信息
J Int AIDS Soc. 2016 Mar 7;19(1):20524. doi: 10.7448/IAS.19.1.20524. eCollection 2016.
INTRODUCTION
HIV controllers (HICs) experience relatively low-level viraemia and CD4 preservation without antiretroviral therapy (ART), but also immune activation that may predispose to adverse clinical events such as cardiovascular disease and hospitalization. The objective of this study was to characterize the rates and reasons for hospitalization among HICs and persons with medically controlled HIV.
METHODS
Subjects with consistently well-controlled HIV were identified in the U.S. Military HIV Natural History Study. ART prescription and HIV-1 RNA data were used to categorize subjects as HICs or medically controlled as defined by ≥ 3 HIV-1 RNA measurements ≤ 2000 or ≤ 400 copies/mL, respectively, representing the majority of measurements spanning ≥ 12 months. Hospitalizations were tallied and assigned diagnostic categories. All-cause hospitalization rates were compared between groups using negative binomial regression.
RESULTS AND DISCUSSION
Of 3106 subjects followed from 2000 to 2013, 221 were HICs, including 33 elite (1.1%) and 188 viraemic (6.0%) controllers, who contributed 882 person-years (PY) of observation time. An additional 870 subjects with medically controlled HIV contributed 4217 PY. Mean hospitalization rates were 9.4/100 PY among HICs and 8.8/100 PY among medically controlled subjects. Non-AIDS-defining infections were the most common reason for hospitalization (2.95/100 PY and 2.70/100 PY, respectively) and rates of cardiovascular hospitalization were similar in both groups (0.45/100 PY and 0.76/100 PY). There was no difference in hospitalization rate for HICs compared with subjects with medically controlled HIV (adjusted incidence rate ratio 1.15 [95% confidence interval 0.80 to 1.65]).
CONCLUSIONS
All-cause and cardiovascular hospitalization rates did not differ between HICs and persons with medically controlled HIV. Non-AIDS defining infections were common in this young, healthy, predominantly male cohort of military personnel and beneficiaries.
引言
HIV病毒控制者（HICs）在未接受抗逆转录病毒治疗（ART）的情况下，病毒血症水平相对较低，CD4细胞得以保存，但同时也存在免疫激活现象，这可能会引发心血管疾病和住院等不良临床事件。本研究的目的是描述HIV病毒控制者和接受药物治疗控制的HIV感染者的住院率及住院原因。
方法
在美国军事HIV自然史研究中确定HIV病情始终得到良好控制的受试者。根据ART处方和HIV-1 RNA数据，将受试者分别归类为HIV病毒控制者或接受药物治疗控制者，定义为分别有≥3次HIV-1 RNA测量值≤2000或≤400拷贝/毫升，代表跨越≥12个月的大多数测量值。统计住院情况并指定诊断类别。使用负二项回归比较两组的全因住院率。
结果与讨论
在2000年至2013年随访的3106名受试者中，有221名是HIV病毒控制者，包括33名精英控制者（1.1%）和188名病毒血症控制者（6.0%），他们贡献了882人年（PY）的观察时间。另外8�0名接受药物治疗控制的HIV感染者贡献了4217人年。HIV病毒控制者的平均住院率为9.4/100人年，接受药物治疗控制的受试者为8.8/100人年。非艾滋病定义性感染是最常见的住院原因（分别为2.95/100人年和2.70/100人年），两组的心血管疾病住院率相似（0.45/10ム人年和0.76/100人年）。与接受药物治疗控制的HIV感染者相比，HIV病毒控制者的住院率没有差异（调整后的发病率比为1.15 [95%置信区间0.80至1.65]）。
结论
HIV病毒控制者和接受药物治疗控制的HIV感染者的全因住院率和心血管疾病住院率没有差异。在这个年轻、健康、以男性为主的军事人员和受益人群体中，非艾滋病定义性感染很常见。
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