Smit Mikaela, Cassidy Rachel, Cozzi-Lepri Alessandro, Quiros-Roldan Eugenia, Girardi Enrico, Mammone Alessia, Antinori Andrea, Saracino Annalisa, Bai Francesca, Rusconi Stefano, Magnani Giacomo, Castelli Francesco, Hsue Priscilla, d'Arminio Monforte Antonella, Hallett Timothy B
Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom.
Department of Infection and Population Health, University College London, London, United Kingdom.
PLoS One. 2017 Oct 23;12(10):e0186638. doi: 10.1371/journal.pone.0186638. eCollection 2017.
Country-specific forecasts of the growing non-communicable disease (NCD) burden in ageing HIV-positive patients will be key to guide future HIV policies. We provided the first national forecasts for Italy and the Unites States of America (USA) and quantified direct cost of caring for these increasingly complex patients.
We adapted an individual-based model of ageing HIV-positive patients to Italy and the USA, which followed patients on HIV-treatment as they aged and developed NCDs (chronic kidney disease, diabetes, dyslipidaemia, hypertension, non-AIDS malignancies, myocardial infarctions and strokes). The models were parameterised using data on 7,469 HIV-positive patients from the Italian Cohort Naïve to Antiretrovirals Foundation Study and 3,748 commercially-insured patients in the USA and extrapolated to national level using national surveillance data.
The model predicted that mean age of HIV-positive patients will increase from 46 to 59 in Italy and from 49 to 58 in the USA in 2015-2035. The proportion of patients in Italy and the USA diagnosed with ≥1 NCD is estimated to increase from 64% and 71% in 2015 to 89% and 89% by 2035, respectively, driven by moderate cardiovascular disease (CVD) (hypertension and dyslipidaemia), diabetes and malignancies in both countries. NCD treatment costs as a proportion of total direct HIV costs will increase from 11% to 23% in Italy and from 40% to 56% in the USA in 2015-2035.
HIV patient profile in Italy and the USA is shifting to older patients diagnosed with multiple co-morbidity. This will increase NCD treatment costs and require multi-disciplinary patient management.
针对老龄化艾滋病毒阳性患者中日益增加的非传染性疾病（NCD）负担进行特定国家的预测，将是指导未来艾滋病毒政策的关键。我们提供了意大利和美利坚合众国（美国）的首个全国性预测，并对护理这些日益复杂患者的直接成本进行了量化。
我们将一个基于个体的老龄化艾滋病毒阳性患者模型应用于意大利和美国，该模型跟踪接受艾滋病毒治疗的患者随着年龄增长并患上非传染性疾病（慢性肾病、糖尿病、血脂异常、高血压、非艾滋病相关恶性肿瘤、心肌梗死和中风）的情况。模型使用来自意大利初治抗逆转录病毒治疗队列基金会研究的7469名艾滋病毒阳性患者的数据以及美国3748名商业保险患者的数据进行参数设置，并利用国家监测数据外推至全国水平。
该模型预测，在2015 - 2035年期间，意大利艾滋病毒阳性患者的平均年龄将从46岁增至59岁，美国则从49岁增至58岁。意大利和美国被诊断患有≥1种非传染性疾病的患者比例预计将分别从2015年的64%和71%增至2035年的89%和89%，这是由两国的中度心血管疾病（CVD）（高血压和血脂异常）、糖尿病和恶性肿瘤推动的。在2015 - 2035年期间，非传染性疾病治疗成本占艾滋病毒直接总成本的比例在意大利将从11%增至23%，在美国将从40%增至56%。
意大利和美国的艾滋病毒患者群体正转向诊断出患有多种合并症的老年患者。这将增加非传染性疾病的治疗成本，并需要多学科的患者管理。
