Guaraldi Giovanni, Zona Stefano, Menozzi Marianna, Brothers Thomas D, Carli Federica, Stentarelli Chiara, Dolci Giovanni, Santoro Antonella, Da Silva Ana Rita Domingues, Rossi Elisa, Falutz Julian, Mussini Cristina
Department of Medical and Surgical Sciences for Adults and Children, Clinic of Infectious Diseases, University of Modena and Reggio Emilia, Emilia-Romagna, Modena, Italy.
Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
AIDS Res Ther. 2017 Feb 16;14(1):8. doi: 10.1186/s12981-016-0129-4.
Late presentation (LP) at the time of HIV diagnosis is defined as presentation with AIDS whatever the CD4 cell count or with CD4 <350 cells/mm. The objective of our study was to assess the prevalence of non-infectious comorbidities (NICM) and multimorbidity among HIV-positive individuals with and without a history of LP (HIV + LP and HIV + EP, respectively), and compare them to matched HIV-negative control participants from a community-based cohort. The secondary objective was to provide estimates and determinants of direct cost of medical care in HIV patients.
We performed a matched cohort study including HIV + LP and HIV + EP among people attending the Modena HIV Metabolic Clinic (MHMC) in 2014. HIV-positive participants were matched in a 1:3 ratio with HIV-negative participants from the CINECA ARNO database. Multimorbidity was defined as the concurrent presence of ≥2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and multimorbidity.
We analyzed 452 HIV + LP and 73 HIV + EP participants in comparison to 1575 HIV-negative controls. The mean age was 46 ± 9 years, 27.5% were women. Prevalence of NICM and multimorbidity were fourfold higher in the HIV + LP compared to the general population (p < 0.001), while HIV + EP present an intermediate risk. LP was associated with increased total costs in all age strata, but appear particularly relevant in patients above 50 years of age, after adjusting for age, multimorbidity, and antiretroviral costs.
LP with HIV infection is still very frequent in Italy, is associated with higher prevalence of NICM and multimorbidity, and contributes to higher total care costs. Encouraging early testing and access to care is still urgently needed.
HIV诊断时的延迟就诊（LP）定义为无论CD4细胞计数如何，出现艾滋病相关症状或CD4细胞计数<350个/mm³。我们研究的目的是评估有和没有LP病史的HIV阳性个体（分别为HIV + LP和HIV + EP）中非感染性合并症（NICM）和多重疾病的患病率，并将它们与来自社区队列的匹配HIV阴性对照参与者进行比较。次要目的是提供HIV患者医疗直接费用的估计值和决定因素。
我们进行了一项匹配队列研究，纳入了2014年在摩德纳HIV代谢诊所（MHMC）就诊的HIV + LP和HIV + EP患者。HIV阳性参与者与来自CINECA ARNO数据库的HIV阴性参与者按1:3的比例进行匹配。多重疾病定义为同时存在≥2种NICM。构建逻辑回归模型以评估NICM和多重疾病相关的预测因素。
我们分析了452例HIV + LP和73例HIV + EP参与者，并与1575例HIV阴性对照进行比较。平均年龄为46±9岁，27.5%为女性。与普通人群相比，HIV + LP中NICM和多重疾病的患病率高出四倍（p < 0.001），而HIV + EP呈现中等风险。LP与所有年龄层的总费用增加相关，但在调整年龄、多重疾病和抗逆转录病毒药物费用后，在50岁以上患者中似乎尤为明显。
在意大利，HIV感染合并LP仍然非常常见，与NICM和多重疾病的较高患病率相关，并导致更高的总护理费用。仍然迫切需要鼓励早期检测和获得治疗。
