Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Clin Infect Dis. 2018 Apr 3;66(8):1230-1238. doi: 10.1093/cid/cix998.
Age-associated conditions are increasingly common among persons living with human immunodeficiency virus (HIV) (PLWH). A longitudinal investigation of their accrual is needed given their implications on clinical care complexity. We examined trends in the co-occurrence of age-associated conditions among PLWH receiving clinical care, and differences in their prevalence by demographic subgroup.
This cohort study was nested within the North American AIDS Cohort Collaboration on Research and Design. Participants from HIV outpatient clinics were antiretroviral therapy-exposed PLWH receiving clinical care (ie, ≥1 CD4 count) in the United States during 2000-2009. Multimorbidity was irreversible, defined as having ≥2: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures.
Among 22969 adults, 79% were male, 36% were black, and the median baseline age was 40 years (interquartile range, 34-46 years). Between 2000 and 2009, multimorbidity prevalence increased from 8.2% to 22.4% (Ptrend < .001). Adjusting for age, this trend was still significant (P < .001). There was no difference by sex, but blacks were less likely than whites to have multimorbidity (aPR, 0.87; 95% CI, .77-.99). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR, 1.16; 95% CI, 1.01-1.34). Hypertension and hypercholesterolemia most commonly co-occurred.
Multimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.
随着年龄的增长，艾滋病毒（HIV）感染者（PLWH）中越来越常见的是与年龄相关的疾病。鉴于这些疾病对临床护理复杂性的影响，需要对其积累情况进行纵向调查。我们检查了接受临床护理的 PLWH 中与年龄相关的疾病同时发生的趋势，并按人口统计学亚组比较了它们的患病率差异。
这项队列研究是北美艾滋病队列合作研究与设计的一部分。研究对象为 2000-2009 年期间在美国接受临床护理（即至少有 1 次 CD4 计数）的 HIV 门诊诊所中的接受过抗逆转录病毒治疗的 PLWH。多重合并症是不可逆转的，定义为患有≥2 种疾病：高血压、糖尿病、慢性肾脏病、高胆固醇血症、终末期肝病或非艾滋病相关癌症。使用广义估计方程对重复测量进行稳健方差的泊松回归，获得了按人口统计学亚组比较的调整后患病率比（aPR）和 95%置信区间（CI）。
在 22969 名成年人中，79%为男性，36%为黑人，中位基线年龄为 40 岁（四分位距，34-46 岁）。2000 年至 2009 年间，多重合并症的患病率从 8.2%上升至 22.4%（Ptrend<.001）。调整年龄后，这种趋势仍然显著（P<.001）。性别之间没有差异，但黑人患多重合并症的可能性低于白人（aPR，0.87；95%CI，0.77-0.99）。异性恋者的多重合并症发生率最高，与男男性行为者（aPR，1.16；95%CI，1.01-1.34）相比。高血压和高胆固醇血症最常同时发生。
PLWH 中的多重合并症患病率有所增加。预防合并症和多专科管理日益复杂的医疗保健需求对于确保他们获得所需的护理至关重要。
