年轻HIV感染者加速衰老对抗逆转录病毒治疗的主要健康影响。

Major health impact of accelerated aging in young HIV-infected individuals on antiretroviral therapy.

作者信息

Rajasuriar Reena, Chong Meng L, Ahmad Bashah Nor S, Abdul Aziz Siti A, Mcstea Megan, Lee Erica C Y, Wong Pui L, Azwa Iskandar, Syed Omar Sharifah F, Lai Pauline S M, Ponampalavanar Sasheela, Crowe Suzanne M, Lewin Sharon R, Kamaruzzaman Shahrul B, Kamarulzaman Adeeba

机构信息

aCentre of Excellence for Research in AIDS bDepartment of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia cThe Peter Doherty Institute for Infection and Immunity, The University of Melbourne dInfectious Diseases Unit, Department of Medicine, Faculty of Medicine eDepartment of Primary Care Medicine, University of Malaya, Kuala Lumpur, Malaysia fDepartment of Infectious Diseases, Monash University and Alfred Hospital, Melbourne gRoyal Melbourne Hospital, Melbourne, Australia hGeriatric Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

出版信息

AIDS. 2017 Jun 19;31(10):1393-1403. doi: 10.1097/QAD.0000000000001475.

DOI:10.1097/QAD.0000000000001475

PMID:28358731

Abstract

BACKGROUND

Aging among HIV-infected individuals on antiretroviral therapy (ART) is a significant clinical challenge; however, studies assessing multidimensional aspects of aging are lacking. We characterized 10 geriatric conditions encompassing multiple functional domains, its health impact and associated risk factors in HIV-infected and age-matched uninfected controls.

METHODS

HIV-infected individuals were recruited from the outpatient clinic in University Malaya Medical Centre, Malaysia and controls from the community. All participants were aged at least 25 years of age with no acute illness, and HIV-infected individuals were on stable ART. Geriatric conditions were assessed and the burden scored as a composite of geriatric conditions present in an individual (total score = 10). Multivariate regression analysis was performed to determine the risk factors and health impact associated with the burden of geriatric conditions.

RESULTS

We analyzed data from 336 HIV-infected individuals (total HIV+), of whom 172 were matched for age, sex, and ethnicity with 172 HIV-uninfected controls (matched subset). In the total HIV-positive cohort, median (interquartile range) age was 44 (38-51) years and CD4 T-cell count was 562 (398-737) cells/μl. The burden of geriatric conditions was significantly higher in the HIV-infected group compared with controls (P < 0.001). With an increasing geriatric condition burden, quality-of-life scores were 2.2-times poorer, healthcare use five times greater, and mortality risk scores four times higher in the HIV-infected group compared with matched controls. Both sociobehavioural and HIV-related clinical factors were independently associated with an increasing burden of geriatric condition in HIV.

CONCLUSIONS

A high burden of geriatric conditions with significant impact on health outcomes, including mortality risk scores are observed among HIV-infected individuals on ART in a resource-limited setting.

摘要

背景

接受抗逆转录病毒疗法（ART）的HIV感染者的老龄化是一项重大的临床挑战；然而，缺乏评估老龄化多维度方面的研究。我们对10种涵盖多个功能领域的老年疾病、其对健康的影响以及HIV感染者和年龄匹配的未感染对照中的相关危险因素进行了特征描述。

方法

从马来西亚马来亚大学医学中心的门诊招募HIV感染者，从社区招募对照。所有参与者年龄至少25岁，无急性疾病，且HIV感染者接受稳定的ART。评估老年疾病，并将负担作为个体中存在的老年疾病的综合评分（总分=10）。进行多变量回归分析以确定与老年疾病负担相关的危险因素和健康影响。

结果

我们分析了336名HIV感染者（HIV阳性总数）的数据，其中172名在年龄、性别和种族上与172名未感染HIV的对照（匹配子集）相匹配。在整个HIV阳性队列中，年龄中位数（四分位间距）为44（38-51）岁，CD4 T细胞计数为562（398-737）个/μl。与对照组相比，HIV感染组的老年疾病负担显著更高（P<0.001）。随着老年疾病负担的增加，HIV感染组的生活质量评分比匹配对照组差2.2倍，医疗保健使用量高5倍，死亡风险评分高4倍。社会行为因素和与HIV相关的临床因素均与HIV感染者老年疾病负担的增加独立相关。