Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
NPS MedicineWise, Sydney, New South Wales, Australia.
PLoS One. 2019 Oct 9;14(10):e0223224. doi: 10.1371/journal.pone.0223224. eCollection 2019.
BACKGROUND: Non-AIDS-related mortality rates among HIV-infected patients still exceed those of their uninfected peers. A major driver of this excess mortality is a higher risk of non-infectious comorbidities, including cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, osteoporosis and cancer. The prevalence of mental illness and other chronic non-infectious comorbidities is identified as a primary concern of antiretroviral prescribers in Australia. METHODS: We conducted a cross-sectional, observational study using data from MedicineInsight, a large-scale Australian primary care database comprising longitudinal data from electronic clinical information systems. The HIV-infected cohort included all men with a recorded diagnosis of HIV. The non-HIV-infected cohort comprised all other men from the same practices. The prevalence and risk of cardiovascular disease, chronic kidney disease, type 2 diabetes mellitus, osteoporosis, cancer, anxiety and depression were compared between the groups. RESULTS: We included 2,406 HIV-infected males and 648,205 males with no record of HIV diagnosis attending primary care in this study. HIV-infected men were less socioeconomically disadvantaged and more urban-dwelling than men in the primary care cohort. We found that HIV-infected men attending primary care in Australia are at increased risk of chronic kidney disease, cancer, osteoporosis, anxiety and depression. There appears to be a risk of premature onset of cardiovascular disease, osteoporosis and cancer among younger HIV-infected patients. There is a high prevalence of anxiety and depression among HIV-infected men. CONCLUSIONS: Increased prevalence of non-infectious comorbidities among HIV-infected men has broad implications for the effective management of those with these chronic conditions. Education to raise awareness among both HIV-infected men and their care providers, together with a greater focus on risk reduction, monitoring and preventive care, may be effective strategies in primary healthcare settings to further narrow the gap in health outcomes between people living with HIV and their uninfected counterparts.
背景：感染 HIV 的患者的非艾滋病相关死亡率仍高于未感染的同龄人。导致这种超额死亡率的一个主要因素是，非传染性合并症的风险更高，包括心血管疾病、慢性肾脏病、2 型糖尿病、骨质疏松症和癌症。精神疾病和其他慢性非传染性合并症的流行被认为是澳大利亚抗逆转录病毒处方者的主要关注点。
方法：我们使用来自 MedicineInsight 的数据进行了一项横断面观察性研究，该数据库是一个大型澳大利亚初级保健数据库，包含来自电子临床信息系统的纵向数据。HIV 感染队列包括所有记录有 HIV 诊断的男性。非 HIV 感染队列包括来自同一实践的所有其他男性。比较了两组人群中心血管疾病、慢性肾脏病、2 型糖尿病、骨质疏松症、癌症、焦虑和抑郁的患病率和风险。
结果：在这项研究中，我们纳入了 2406 名感染 HIV 的男性和 648205 名没有 HIV 诊断记录的男性，他们在初级保健中接受治疗。与初级保健队列中的男性相比，感染 HIV 的男性社会经济地位较低，居住在城市的比例较高。我们发现，在澳大利亚接受初级保健的感染 HIV 的男性患慢性肾脏病、癌症、骨质疏松症、焦虑和抑郁的风险增加。年轻的 HIV 感染者似乎存在心血管疾病、骨质疏松症和癌症发病过早的风险。感染 HIV 的男性中焦虑和抑郁的患病率较高。
结论：感染 HIV 的男性中非传染性合并症的患病率增加，这对有效管理这些慢性疾病具有广泛的影响。提高 HIV 感染者及其护理人员的认识的教育，以及更注重降低风险、监测和预防保健，可能是初级保健环境中进一步缩小 HIV 感染者与未感染者之间健康结果差距的有效策略。
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