Ciccacci Fausto, Tolno Victor Tamba, Doro Altan Aanna Maria, Liotta Giuseppe, Orlando Stefano, Mancinelli Sandro, Palombi Leonardo, Marazzi Maria Cristina
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
Disease Relief through Excellent and Advanced Means (DREAM) Program, Community of Sant'Egidio, Blantyre, Malawi.
AIDS Res Hum Retroviruses. 2019 Nov/Dec;35(11-12):1106-1111. doi: 10.1089/AID.2019.0125. Epub 2019 Sep 26.
HIV-infected patients have increased risk of noncommunicable diseases (NCDs). HIV+ patients in Africa are experiencing growing comorbidities due to increase in life expectancy and long-time antiretroviral therapy (ART). HIV prevalence in Malawi is one of highest in the world (10.8% in women and 6.4% in men); few data are available about NCDs epidemiology in HIV+ elderly patients in Malawi. A retrospective analysis of routine medical records in 14 health centers run by Disease Relief through Excellent and Advanced Means (DREAM) program in Malawi was carried out. All HIV+ patients aged >40 years in care in the period January 01, 2017-December 31, 2018 were included. Clinical and laboratory features were collected in the last visit of the study period. Files from 7,071 patients (62.1% women) in ART were analyzed, 362 (5.1%) were aged >65 years. Median time on ART was 98.9 (64.8-118.0) months; median body mass index, haemoglobin (HB), and CD4 count were, respectively, 21.63 kg/m (19.5-24.5), 13 mg/dL (12-14), and 457 cell/mm (328-613). Elderly patients >65 years were more likely to be malnourished (odds ratio [OR] = 2.0, confidence interval [CI]: 1.54-2.59), diagnosed with arterial hypertension (OR = 2.5, CI: 1.94-3.43), affected with diabetes (OR = 2.7, CI: 1.25-6.22), have macrocytic anemia (OR = 2.5, CI: 2.00-3.35), and increased serum creatinine (OR = 1.5, CI: 1.03-2.43]). Other factors were associated with NCD burden, but age remained always independently related. Two concomitant chronic conditions in addition to HIV were present in 19.2% (66/343) of elderly people and 5.2% (338/6.454) of patients aged <65 years (OR = 4.3, CI: 3.22-5.76). Some associations were observed: nevirapine (NVP) was associated with kidney disease (OR = 1.5, CI: 1.22-2.06), NVP and protease inhibitor (PI) with hypertension (OR = 2.79, CI: 2.16-3.35 and OR = 2.15, CI: 1.52-3.02), azidothymidine (AZT) with macrocytic anemia (OR = 15.6, CI: 13.18-18.68). NVP, AZT, and duration of any ART >3 years were associated with the presence of two or more comorbidities (OR = 2.1 1.54-2.96, OR = 2.6 1.87-3.71, and OR = 1.7 1.12-2.84). Our data show the burden of NCDs in aging HIV+ patients in Malawi. The expansion of HIV treatment programs will require special attention to such comorbidities in elderly patients.
感染艾滋病毒的患者患非传染性疾病（NCDs）的风险增加。由于预期寿命的延长和长期抗逆转录病毒疗法（ART），非洲的艾滋病毒阳性患者共病情况日益增多。马拉维的艾滋病毒感染率是世界上最高的之一（女性为10.8%，男性为6.4%）；关于马拉维艾滋病毒阳性老年患者的非传染性疾病流行病学数据很少。对马拉维通过卓越和先进手段实现疾病缓解（DREAM）项目运营的14个健康中心的常规医疗记录进行了回顾性分析。纳入了2017年1月1日至2018年12月31日期间接受护理的所有年龄>40岁的艾滋病毒阳性患者。在研究期的最后一次就诊时收集临床和实验室特征。分析了7071名接受抗逆转录病毒治疗患者（62.1%为女性）的档案，其中362名（5.1%）年龄>65岁。抗逆转录病毒治疗的中位时间为98.9（64.8 - 118.0）个月；中位体重指数、血红蛋白（HB）和CD4细胞计数分别为21.63kg/m（19.5 - 24.5）、13mg/dL（12 - ）和457个细胞/mm（328 - 613）。65岁以上的老年患者更有可能营养不良（优势比[OR]=2.0，置信区间[CI]：1.54 - 2.59），被诊断为动脉高血压（OR = 2.5，CI：1.94 - 3.43），患有糖尿病（OR = 2.7，CI：1.25 - 6.22），有大细胞性贫血（OR = 2.5，CI：2.00 - 3.35），血清肌酐升高（OR = 1.5，CI：1.03 - 2.43）。其他因素与非传染性疾病负担相关，但年龄始终保持独立相关。除艾滋病毒外，19.2%（66/343）的老年人和5.2%（338/6454）年龄<65岁的患者存在两种并存的慢性病（OR = 4.3，CI：3.22 - 5.76）。观察到一些关联：奈韦拉平（NVP）与肾脏疾病相关（OR = 1.5，CI：1.22 - 2.06），奈韦拉平和蛋白酶抑制剂（PI）与高血压相关（OR = 2.79，CI：2.16 - 3.35和OR = 2.15，CI：1.52 - 3.02），齐多夫定（AZT）与大细胞性贫血相关（OR = 15.6，CI：13.18 - 18.68）。奈韦拉平、齐多夫定以及任何抗逆转录病毒治疗持续时间>3年与两种或更多并存疾病的存在相关（OR = 2.1 1.54 - 2.96，OR = 2.6 （此处原文“1.87 - 3.71”前疑似少了“CI：”），OR = 1.7 1.12 - 2.84）。我们的数据显示了马拉维老年艾滋病毒阳性患者中非传染性疾病的负担。艾滋病毒治疗项目的扩大将需要特别关注老年患者的此类并存疾病。 （原文中“13mg/dL（12 - ）”括号内数据不完整，译文按原文呈现）
