美国社区卫生中心接受初级保健的 HIV 感染患者存在过度临床合并症。
Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers.
机构信息
1 The Fenway Institute, Fenway Health, Boston, MA, USA.
2 Harvard Medical School, Boston, MA, USA.
出版信息
Public Health Rep. 2018 Jan/Feb;133(1):109-118. doi: 10.1177/0033354917748670. Epub 2017 Dec 20.
OBJECTIVES
As the life expectancy of people infected with human immunodeficiency virus (HIV) infection has increased, the spectrum of illness has evolved. We evaluated whether people living with HIV accessing primary care in US community health centers had higher morbidity compared with HIV-uninfected patients receiving care at the same sites.
METHODS
We compared data from electronic health records for 12 837 HIV-infected and 227 012 HIV-uninfected patients to evaluate the relative prevalence of diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, and malignancies by HIV serostatus. We used multivariable logistic regression to evaluate differences. Participants were patients aged ≥18 who were followed for ≥3 years (from January 2006 to December 2016) in 1 of 17 community health centers belonging to the Community Health Applied Research Network.
RESULTS
Nearly two-thirds of HIV-infected and HIV-uninfected patients lived in poverty. Compared with HIV-uninfected patients, HIV-infected patients were significantly more likely to be diagnosed and/or treated for diabetes (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.22-1.41), hypertension (OR = 1.38; 95% CI, 1.31-1.46), dyslipidemia (OR = 2.30; 95% CI, 2.17-2.43), chronic kidney disease (OR = 4.75; 95% CI, 4.23-5.34), lymphomas (OR = 4.02; 95% CI, 2.86-5.67), cancers related to human papillomavirus (OR = 5.05; 95% CI, 3.77-6.78), or other cancers (OR = 1.25; 95% CI, 1.10-1.42). The prevalence of stroke was higher among HIV-infected patients (OR = 1.32; 95% CI, 1.06-1.63) than among HIV-uninfected patients, but the prevalence of myocardial infarction or coronary artery disease did not differ between the 2 groups.
CONCLUSIONS
As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.
目的
随着感染人类免疫缺陷病毒（HIV）的人群预期寿命的延长，疾病谱也发生了演变。我们评估了在美国社区卫生中心接受初级保健的 HIV 感染者与在同一地点接受 HIV 阴性患者护理的患者相比，发病率是否更高。
方法
我们比较了来自电子健康记录的 12837 名 HIV 感染者和 227012 名 HIV 阴性患者的数据，以评估 HIV 血清学状态下糖尿病、高血压、慢性肾脏病、血脂异常和恶性肿瘤的相对患病率。我们使用多变量逻辑回归来评估差异。参与者为年龄≥18 岁的患者，在 17 个社区卫生中心中的 1 个社区卫生中心接受了≥3 年（2006 年 1 月至 2016 年 12 月）的随访，这些社区卫生中心隶属于社区卫生应用研究网络。
结果
近三分之二的 HIV 感染者和 HIV 阴性患者生活贫困。与 HIV 阴性患者相比，HIV 感染者更有可能被诊断和/或治疗糖尿病（比值比[OR] = 1.18；95%置信区间[CI]，1.22-1.41）、高血压（OR = 1.38；95%CI，1.31-1.46）、血脂异常（OR = 2.30；95%CI，2.17-2.43）、慢性肾脏病（OR = 4.75；95%CI，4.23-5.34）、淋巴瘤（OR = 4.02；95%CI，2.86-5.67）、与人类乳头瘤病毒相关的癌症（OR = 5.05；95%CI，3.77-6.78）或其他癌症（OR = 1.25；95%CI，1.10-1.42）。HIV 感染者的中风患病率较高（OR = 1.32；95%CI，1.06-1.63），高于 HIV 阴性患者，但两组心肌梗死或冠心病的患病率无差异。
结论
随着 HIV 感染者寿命的延长，非传染性疾病负担的增加可能会使他们的临床管理复杂化，这需要初级保健提供者接受针对这一人群的慢性病管理培训。
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