Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), Montreal, Canada.
Internal Medicine Service, CHUM, Tour Saint-Antoine - 1st Floor, Room SO1-134, 850, rue Saint-Denis, Montréal, Québec, H2X 0A9, Canada.
Clin Rheumatol. 2021 Jun;40(6):2439-2445. doi: 10.1007/s10067-020-05500-x. Epub 2020 Nov 23.
The objective of this paper is to estimate incidence and relative risk of autoimmune conditions in patients living with HIV compared to an HIV-negative matched population. We conducted a retrospective study in the medico-administrative database of the province of Québec, Canada. All HIV-positive patients treated with antiretrovirals were matched to up to 4 HIV-negative controls for age, sex, and period of follow-up. The following autoimmune conditions were identified using medical billing codes: vasculitis, hematological (immune thrombocytopenic purpura and immune hemolytic anemia), ankylosing spondylitis, psoriasis and psoriatic arthritis, inflammatory bowel disease and associated arthritis, connectivitis, and systemic lupus erythematosus. Incidence rates and adjusted hazard ratios (aHR) were obtained using survival models. A total of 4245 HIV-positive patients were matched to 16493 HIV-negative patients. Autoimmune diseases were diagnosed in 407 (9.6%) HIV-positive and 508 (3%) HIV-negative patients. The aHR for autoimmune diseases associated to HIV was 2.40 95% CI [2.10-2.75]. The strongest associations were seen for hematological disorders (aHR 8.34 95% CI [6.13-11.36]), followed by ankylosing spondylitis (1.82 95% CI [1.03-3.21]), inflammatory bowel disease and associated arthritis (1.80 95% CI [1.37-2.35]), psoriasis and associated arthritis (1.69 95% CI [1.23-2.33]), and rheumatoid arthritis (1.51 95% CI [1.08-2.11]).We found no association between HIV and the incidence of vasculitis, connectivitis, and systemic lupus erythematosus, but the number of cases for these diseases were few. Autoimmune diseases are more frequent among people living with HIV than age and sex-matched population-based controls. Key Points • Strength: The major strength of this study is its large sample size of 4200 people treated as HIV infection, matched to 16000 HIV negative for sex and age. • Novelty: We found that people living with HIV were more than twice as likely to suffer from auto-immune diseases than their matched counterparts.
本文旨在评估与 HIV 阴性匹配人群相比，HIV 感染者发生自身免疫性疾病的发病率和相对风险。我们在加拿大魁北克省的医疗管理数据库中进行了一项回顾性研究。所有接受抗逆转录病毒治疗的 HIV 阳性患者均按年龄、性别和随访时间与至多 4 名 HIV 阴性对照相匹配。使用医疗计费代码确定以下自身免疫性疾病：血管炎、血液学疾病（免疫性血小板减少性紫癜和免疫性溶血性贫血）、强直性脊柱炎、银屑病和银屑病关节炎、炎症性肠病和相关关节炎、结缔组织疾病和系统性红斑狼疮。使用生存模型获得发病率和调整后的危险比（aHR）。共纳入 4245 名 HIV 阳性患者和 16493 名 HIV 阴性患者进行匹配。407 名（9.6%）HIV 阳性患者和 508 名（3%）HIV 阴性患者被诊断为自身免疫性疾病。与 HIV 相关的自身免疫性疾病的 aHR 为 2.40[95%CI：2.10-2.75]。与 HIV 相关的自身免疫性疾病最强的关联见于血液学疾病（aHR 8.34[95%CI：6.13-11.36]），其次是强直性脊柱炎（aHR 1.82[95%CI：1.03-3.21]）、炎症性肠病和相关关节炎（aHR 1.80[95%CI：1.37-2.35]）、银屑病和相关关节炎（aHR 1.69[95%CI：1.23-2.33]）和类风湿关节炎（aHR 1.51[95%CI：1.08-2.11]）。我们发现 HIV 与血管炎、结缔组织疾病和系统性红斑狼疮的发病率之间无关联，但这些疾病的病例数较少。与年龄和性别匹配的基于人群的对照组相比，HIV 感染者发生自身免疫性疾病的频率更高。要点：• 优势：本研究的主要优势在于其样本量大，共纳入 4200 名接受 HIV 感染治疗的患者，与 16000 名 HIV 阴性患者进行性别和年龄匹配。• 新颖性：我们发现，与他们的匹配对照相比，HIV 感染者患自身免疫性疾病的可能性是其两倍多。
