全球艾滋病毒感染者的动脉粥样硬化性心血管疾病负担：系统评价和荟萃分析。
Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis.
机构信息
BHF Centre for Cardiovascular Science, University of Edinburgh, Scotland (A.S.V.S., K.K.L., S.A., S.C., F.S., D.E.N., N.L.M.).
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (A.S.V.S., H.N.).
出版信息
Circulation. 2018 Sep 11;138(11):1100-1112. doi: 10.1161/CIRCULATIONAHA.117.033369.
BACKGROUND
With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the association between HIV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HIV.
METHODS
We conducted a systematic review across 5 databases from inception to August 2016 for longitudinal studies of cardiovascular disease in HIV infection. A random-effects meta-analysis across 80 studies was used to derive the pooled rate and risk of cardiovascular disease in people living with HIV. We then estimated the temporal changes in the population-attributable fraction and disability-adjusted life-years (DALYs) from HIV-associated cardiovascular disease from 1990 to 2015 at a regional and global level. National cardiovascular DALYs associated with HIV for 2015 were derived for 154 of the 193 United Nations member states. The main outcome measure was the pooled estimate of the rate and risk of cardiovascular disease in people living with HIV and the national, regional, and global estimates of DALYs from cardiovascular disease associated with HIV.
RESULTS
In 793 635 people living with HIV and a total follow-up of 3.5 million person-years, the crude rate of cardiovascular disease was 61.8 (95% CI, 45.8-83.4) per 10 000 person-years. In comparison with individuals without HIV, the risk ratio for cardiovascular disease was 2.16 (95% CI, 1.68-2.77). Over the past 26 years, the global population-attributable fraction from cardiovascular disease attributable to HIV increased from 0.36% (95% CI, 0.21%-0.56%) to 0.92% (95% CI, 0.55%-1.41%), and DALYs increased from 0.74 (95% CI, 0.44-1.16) to 2.57 (95% CI, 1.53-3.92) million. There was marked regional variation with most DALYs lost in sub-Saharan Africa (0.87 million, 95% CI, 0.43-1.70) and the Asia Pacific (0.39 million, 95% CI, 0.23-0.62) regions. The highest population-attributable fraction and burden were observed in Swaziland, Botswana, and Lesotho.
CONCLUSIONS
People living with HIV are twice as likely to develop cardiovascular disease. The global burden of HIV-associated cardiovascular disease has tripled over the past 2 decades and is now responsible for 2.6 million DALYs per annum with the greatest impact in sub-Saharan Africa and the Asia Pacific regions.
CLINICAL TRIAL REGISTRATION
URL: https://www.crd.york.ac.uk/prospero . Unique identifier: CRD42016048257.
背景
随着抗逆转录病毒疗法的进步，大多数艾滋病毒感染者的死亡现在归因于非传染性疾病，尤其是心血管疾病。我们确定了艾滋病毒与心血管疾病之间的关联，并估计了艾滋病毒导致的心血管疾病在全球、区域和国家的负担。
方法
我们对从 1990 年至 2015 年期间在 5 个数据库中进行的艾滋病毒感染患者心血管疾病的纵向研究进行了系统回顾。通过对 80 项研究的随机效应荟萃分析，得出了艾滋病毒感染者心血管疾病的合并发生率和风险。然后，我们估计了在区域和全球范围内，艾滋病毒相关心血管疾病的人群归因分数和残疾调整生命年（DALY）的时间变化。我们为 2015 年的 193 个联合国会员国中的 154 个国家推导了与艾滋病毒相关的心血管疾病的全国心血管 DALY。主要观察指标是艾滋病毒感染者心血管疾病的合并发生率和风险的汇总估计值，以及与艾滋病毒相关的心血管疾病的全球、区域和国家 DALY 估计值。
结果
在 793635 名艾滋病毒感染者中，总随访时间为 350 万人年，心血管疾病的粗发生率为 61.8（95%CI，45.8-83.4）/10000 人年。与未感染艾滋病毒的个体相比，心血管疾病的风险比为 2.16（95%CI，1.68-2.77）。在过去的 26 年中，全球因艾滋病毒导致的心血管疾病的人群归因分数从 0.36%（95%CI，0.21%-0.56%）增加到 0.92%（95%CI，0.55%-1.41%），残疾调整生命年（DALY）从 0.74（95%CI，0.44-1.16）增加到 2.57（95%CI，1.53-3.92）百万。存在明显的区域差异，撒哈拉以南非洲地区（0.87 百万，95%CI，0.43-1.70）和亚太地区（0.39 百万，95%CI，0.23-0.62）损失了大部分 DALY。斯威士兰、博茨瓦纳和莱索托的人群归因分数和负担最高。
结论
艾滋病毒感染者发生心血管疾病的风险是未感染者的两倍。在过去的 20 年中，艾滋病毒相关心血管疾病的全球负担增加了两倍，每年导致 260 万人残疾调整生命年（DALY），在撒哈拉以南非洲和亚太地区的影响最大。
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