在接受艾滋病毒护理的老年人群中，非艾滋病合并症负担因性别、种族和保险类型而异。
Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care.
机构信息
aNorthwestern University Feinberg School of Medicine, Chicago, Illinois bCerner Corporation, Kansas City, Missouri cTemple University School of Medicine, Philadelphia, Pennsylvania dInfectious Disease Research Institute, Inc., Tampa, Florida eUniversity of Illinois at Chicago, Chicago, Illinois fColorado School of Mines, Golden, Colorado gDupont Circle Physicians Group, Washington, District of Columbia hU.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
出版信息
AIDS. 2019 Dec 1;33(15):2327-2335. doi: 10.1097/QAD.0000000000002349.
OBJECTIVE
To understand the epidemiology of non-AIDS-related chronic comorbidities (NACMs) among aging persons with HIV (PWH).
DESIGN
Prospective multicenter observational study to assess, in an age-stratified fashion, number and types of NACMs by demographic and HIV factors.
METHODS
Eligible participants were seen during 1 January 1997 to 30 June 2015, followed for more than 5 years, received antiretroviral therapy (ART), and virally suppressed (HIV viral load <200 copies/ml ≥75% of observation time). Age was stratified (18-40, 41-50, 51-60, ≥61 years). NACMs included cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, arthritis, viral hepatitis, anemia, and psychiatric illness.
RESULTS
Of 1540 patients, 1247 (81%) were men, 406 (26%) non-Hispanic blacks (NHB), 183 (12%) Hispanics/Latinos, 575 (37%) with public insurance, 939 (61%) MSM, and 125 (8%) with injection drug use history. By age strata 18-40, 41-50, 51-60, and at least 61 years, there were 180, 502, 560, and 298 patients, respectively. Median HIV Outpatient Study observation was 10.8 years (range: min-max = 5.0-18.5). Mean number of NACMs increased with older age category (1.4, 2.1, 3.0, and 3.9, respectively; P < 0.001), as did prevalence of most NACMs (P < 0.001). Age-related differences in NACM numbers were primarily due to anemia, hepatitis C virus infection, and diabetes. Differences (all P < 0.05) in NACM number existed by sex (women >men, 3.9 vs. 3.4), race/ethnicity (NHB >non-NHB, 3.8 vs. 3.4), and insurance status (public >private, 4.3 vs. 3.1).
CONCLUSIONS
Age-related increases existed in prevalence and number of NACMs, with disproportionate burden among women, NHBs, and the publicly insured. These groups should be targeted for screening and prevention strategies aimed at NACM reduction.
目的
了解老年 HIV 感染者（PWH）中非 AIDS 相关慢性合并症（NACMs）的流行病学情况。
设计
前瞻性多中心观察性研究，按年龄分层，根据人口统计学和 HIV 因素评估 NACMs 的数量和类型。
方法
符合条件的参与者于 1997 年 1 月 1 日至 2015 年 6 月 30 日期间接受了检查，随访时间超过 5 年，接受了抗逆转录病毒治疗（ART），病毒载量受到抑制（HIV 病毒载量 <200 拷贝/ml，≥75%观察时间）。年龄分层（18-40 岁、41-50 岁、51-60 岁、≥61 岁）。NACMs 包括心血管疾病、癌症、高血压、糖尿病、血脂异常、关节炎、病毒性肝炎、贫血和精神疾病。
结果
在 1540 名患者中，1247 名（81%）为男性，406 名（26%）为非西班牙裔黑人（NHB），183 名（12%）为西班牙裔/拉丁裔，575 名（37%）有公共保险，939 名（61%）为男男性行为者（MSM），125 名（8%）有注射吸毒史。在年龄组 18-40 岁、41-50 岁、51-60 岁和至少 61 岁的患者中，分别有 180、502、560 和 298 例患者。HIV 门诊研究观察的中位时间为 10.8 年（范围：最小值-最大值=5.0-18.5）。随着年龄组的增加，NACMs 的平均数量也随之增加（分别为 1.4、2.1、3.0 和 3.9，P<0.001），大多数 NACMs 的患病率也随之增加（P<0.001）。年龄相关的 NACM 数量差异主要归因于贫血、丙型肝炎病毒感染和糖尿病。NACM 数量的性别差异（女性>男性，3.9 与 3.4）、种族/民族差异（NHB>非 NHB，3.8 与 3.4）和保险状况差异（公共>私人，4.3 与 3.1）均具有统计学意义（均 P<0.05）。
结论
NACMs 的患病率和数量随年龄增长而增加，女性、非西班牙裔黑人和公共保险者的负担不成比例。这些群体应作为目标人群，制定旨在减少 NACM 的筛查和预防策略。
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