Portilla-Tamarit Julia, Reus Sergio, Portilla Irene, Fuster Ruiz-de-Apodaca María José, Portilla Joaquín
Infectious Diseases Unit, Internal Medicine Department, Alicante University General Hospital, 03010 Alicante, Spain.
Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain.
J Clin Med. 2021 Feb 11;10(4):716. doi: 10.3390/jcm10040716.
Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.
目前，艾滋病或严重免疫缺陷仍然是艾滋病毒感染者（PWHIV）和医疗服务提供者面临的一项挑战。我们的目的是分析晚期HIV疾病（AHD）对死亡率、预期寿命和健康相关生活质量（HRQoL）的影响。我们回顾了在中高收入国家开展的队列研究和荟萃分析。为了分析健康相关生活质量，我们选择了那些在经过验证的健康相关生活质量工具上报告了总体健康和/或身体/心理健康评分的研究。艾滋病诊断意味着在最初六个月内死亡风险更高，且在48个月内一直保持较高水平。据报道，癌症和心血管疾病仍然是艾滋病毒感染者死亡的常见原因，尤其是那些既往或目前患有晚期HIV疾病的患者。开始接受联合抗逆转录病毒治疗（cART）时CD4细胞计数<200个/µL的艾滋病毒感染者的预期寿命明显低于计数较高者。晚期HIV疾病与较低的健康相关生活质量以及较差的身体健康或心理健康状况相关。艾滋病和非艾滋病定义事件是健康相关生活质量较低的重要预测因素，尤其是身体健康状况。晚期HIV疾病幸存者存在死亡和严重合并症风险，需要针对相关合并症给予特殊临床关注和预防方案。他们的特殊需求应反映在HIV指南中。
