不列颠哥伦比亚省 HIV 感染者的合并症和多药治疗。

Comorbidity and polypharmacy among women living with HIV in British Columbia.

机构信息

aDepartment of Medicine, University of British Columbia (UBC) bOak Tree Clinic, BC Women's Hospital cWomen's Health Research Institute, BC Women's Hospital dDepartment of Pathology and Laboratory Medicine, UBC eDivision of Infectious Diseases, Department of Medicine, UBC, Vancouver, Canada.

出版信息

AIDS. 2019 Dec 1;33(15):2317-2326. doi: 10.1097/QAD.0000000000002353.

DOI:10.1097/QAD.0000000000002353

PMID:31764097

Abstract

OBJECTIVE

To characterize comorbid disease and medication burden among women living with HIV (WLWH) in British Columbia (BC), Canada.

DESIGN

We examined baseline data from 267 WLWH and 276 HIV-negative women, aged at least 19 years, enrolled in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort.

METHODS

Self-reported demographic, medical condition, medication, vitamin, and substance exposure data were collected at baseline CARMA study visits. We considered conditions with appropriate concomitant medications to be 'treated'. Wilcoxon rank-sum and Fisher's exact tests compared continuous and categorical variables between WLWH and HIV-negative women. Number of diagnoses, prescribed medications (excluding HIV/antiretrovirals), vitamins, and prevalence of depression/anxiety/panic disorder were compared using negative binomial and logistic regressions for continuous and binary variables, respectively.

RESULTS

WLWH were younger [median, interquartile range (IQR) 39.9, 33.6-46.9 vs. 43.6, 31.8-54.6 years; P = 0.01], attained lower education (40.5 vs. 69.6% college/university; P < 0.001), and more often currently smoked tobacco (47.9 vs. 31.9%; P < 0.001) or had income less than $15 000/year (49.0 vs. 43.1%; P < 0.001). Although younger, and despite omitting HIV infection, WLWH had a greater number of diagnoses (incidence rate ratio, 95% confidence interval 1.58, 1.38-1.81; P < 0.001), and more depression/anxiety/panic disorder vs. controls (odds ratio, 95% CI 1.86, 1.22-2.83; P = 0.004). Our model predicts that with mean BMI (26.3), WLWH and HIV-negative peers would have two comorbid diagnoses by age 30 and 60, respectively.

CONCLUSIONS

WLWH living in BC have more comorbid illness earlier in life than their HIV-negative peers, and have very high rates of depression/anxiety/panic disorder. Addressing mental health and comorbid conditions is essential to improving health outcomes among WLWH.

摘要

目的

描述加拿大不列颠哥伦比亚省（BC）HIV 阳性女性（WLWH）的合并疾病和药物负担情况。

设计

我们分析了儿童和妇女：抗逆转录病毒和衰老标志物（CARMA）队列中 267 名 WLWH 和 276 名 HIV 阴性女性的基线数据。

方法

在 CARMA 研究访问时，收集了自我报告的人口统计学、医疗状况、药物、维生素和物质暴露数据。我们认为有适当伴随药物治疗的疾病为“治疗”。Wilcoxon 秩和检验和 Fisher 精确检验比较了 WLWH 和 HIV 阴性女性之间的连续和分类变量。采用负二项回归和逻辑回归分别比较了连续和二分类变量的诊断数量、开处方药物（不包括 HIV/抗逆转录病毒药物）、维生素以及抑郁/焦虑/惊恐障碍的患病率。

结果

WLWH 更年轻[中位数，四分位距（IQR）39.9，33.6-46.9 岁 vs. 43.6，31.8-54.6 岁；P=0.01]，教育程度较低（40.5% vs. 69.6%的大学/大学；P<0.001），当前吸烟（47.9% vs. 31.9%；P<0.001）或收入低于 15000 加元/年（49.0% vs. 43.1%；P<0.001）的比例更高。尽管年轻，但由于不包括 HIV 感染，WLWH 的诊断数量更多（发病率比，95%置信区间 1.58，1.38-1.81；P<0.001），并且抑郁/焦虑/惊恐障碍的比例高于对照组（比值比，95%置信区间 1.86，1.22-2.83；P=0.004）。我们的模型预测，在平均 BMI（26.3）的情况下，WLWH 和 HIV 阴性同龄人分别在 30 岁和 60 岁时会有两个合并诊断。