Haacker Markus, Bärnighausen Till, Atun Rifat
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Centre for Global Health Economics, University College, London, UK.
J Glob Health. 2019 Jun;9(1):010428. doi: 10.7189/jogh.09.010428.
The "greying of AIDS" - the aging of the population living with HIV who benefit from antiretroviral treatment (ART) and the emergence of age-related non-communicable diseases (NCDs) - has been well documented. The emerging health systems challenges - eg, the implications of HIV on the disease burden from NCDs on the population level, and the evolving role of HIV as a co-morbidity or co-existing disease of various NCDs - are less well understood. The paper elucidates these challenges by providing a quantitative analysis of HIV-NCD interactions for Botswana.
We projected the prevalence of HIV and of selected NCDs in Botswana using demographic and HIV-specific estimates building on data on the state and the dynamics of the HIV epidemic, using the Spectrum modelling software, and extrapolating on estimates of the prevalence of NCDs from the 2015 global burden of disease (GBD).
HIV has slowed down overall population aging and thus has attenuated the growing burden of many NCDs so far, because cohorts reaching old age have been decimated by AIDS-related mortality in the 1990s and early 2000s. Aging and the rise in the prevalence of NCDs, however, will accelerate rapidly from about 2030 because of reduced attrition of cohorts living with HIV since the start of the ART scale-up in Botswana. While HIV prevalence will decline over time, the health needs of people living with HIV will become more complex. HIV prevalence among the growing populations affected by various important NCDs will not decline for decades, because of the aging of the population living with HIV and interactions between HIV, ART and NCDs.
Even though HIV prevalence is projected to decline steeply to 2030 because of reduced HIV incidence, the prevalence of HIV among people affected by many of the most important NCDs will increase or barely change. While the health care needs of people living with HIV will increase and become more complex, HIV will also emerge as a key factor complicating the management of the growing burden of NCDs. Health systems will need to prepare for the challenge of large numbers of patients living with both HIV and NCDs.
“艾滋病的老龄化”——即受益于抗逆转录病毒治疗（ART）的艾滋病毒感染者群体的老龄化以及与年龄相关的非传染性疾病（NCDs）的出现——已有充分记录。而新出现的卫生系统挑战，例如艾滋病毒对人群层面非传染性疾病疾病负担的影响，以及艾滋病毒作为各种非传染性疾病的合并症或并存疾病所不断演变的作用，则鲜为人知。本文通过对博茨瓦纳艾滋病毒与非传染性疾病的相互作用进行定量分析，阐明了这些挑战。
我们利用Spectrum建模软件，基于艾滋病毒流行状况和动态数据中的人口统计学及特定艾滋病毒估计数，对博茨瓦纳的艾滋病毒及选定非传染性疾病的患病率进行预测，并根据2015年全球疾病负担（GBD）中对非传染性疾病患病率的估计数进行外推。
艾滋病毒减缓了总体人口老龄化，因此到目前为止减轻了许多非传染性疾病日益加重的负担，这是因为在20世纪90年代和21世纪初，达到老年的人群因艾滋病相关死亡率而大量减少。然而，由于自博茨瓦纳扩大抗逆转录病毒治疗规模以来，艾滋病毒感染者群体的损耗减少，老龄化和非传染性疾病患病率的上升将从2030年左右开始迅速加速。虽然艾滋病毒患病率将随着时间推移而下降，但艾滋病毒感染者的健康需求将变得更加复杂。由于艾滋病毒感染者群体的老龄化以及艾滋病毒、抗逆转录病毒治疗和非传染性疾病之间的相互作用，在受各种重要非传染性疾病影响的不断增长的人群中，艾滋病毒患病率在几十年内不会下降。
尽管由于艾滋病毒发病率降低，预计到2030年艾滋病毒患病率将大幅下降，但在受许多最重要非传染性疾病影响的人群中，艾滋病毒患病率将上升或几乎不变。虽然艾滋病毒感染者的医疗保健需求将增加且变得更加复杂，但艾滋病毒也将成为使日益加重的非传染性疾病负担管理复杂化的关键因素。卫生系统需要为大量同时感染艾滋病毒和非传染性疾病的患者带来的挑战做好准备。
