British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
BMJ Open. 2021 Jan 8;11(1):e041734. doi: 10.1136/bmjopen-2020-041734.
As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.
This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.
The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.
The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer's and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.
Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer's and/or dementia.
PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.
随着艾滋病毒感染者（PLWH）寿命的延长，非艾滋病合并症的发病率和死亡率已成为主要关注点。我们的目的是比较艾滋病毒感染者和非感染者中九种与年龄相关的慢性合并症的流行趋势和诊断年龄。
这项基于人群的队列研究使用了加拿大不列颠哥伦比亚省所有接受抗逆转录病毒治疗的 PLWH 和 1:4 年龄性别匹配的 HIV 阴性个体的纵向队列数据。
该研究包括 8031 名接受抗逆转录病毒治疗的 PLWH 和 32124 名 HIV 阴性对照者（中位年龄 40 岁，82%为男性）。合格的参与者年龄≥19 岁，在 2000 年至 2012 年期间至少随访 1 年。
从省级行政数据库中确定了非艾滋病定义的癌症、糖尿病、骨关节炎、高血压、阿尔茨海默病和/或非 HIV 相关痴呆症、心血管疾病、肾脏疾病、肝脏疾病和肺部疾病的存在。贝塔回归评估了每年按年龄和性别标准化的流行趋势，Kruskal-Wallis 检验比较了按医疗保健就诊率分层的合并症的诊断年龄。
在整个研究期间，与社区 HIV 阴性对照者相比，PLWH 患所有慢性年龄相关合并症（除高血压外）的比例均较高；肝脏疾病的比例高达 10 倍（25.3%比 2.1%，p 值<0.0001）。按医疗保健就诊率分层，PLWH 经历的大多数慢性年龄相关疾病比 HIV 阴性对照者更早，早至 21 年的阿尔茨海默病和/或痴呆症。
PLWH 患非艾滋病合并症的比例和诊断年龄均高于 HIV 阴性对照者。这些结果强调了在 PLWH 中更优化地进行合并症筛查的必要性，以及需要建立一种综合的 HIV 护理模式，将慢性年龄相关疾病的预防和治疗相结合。此外，本研究中开发的稳健方法解决了使用行政健康数据来衡量患病率和发病率的问题，该方法在其他环境中也具有可重复性。
