Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA.
Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
AIDS Patient Care STDS. 2021 Jul;35(7):239-248. doi: 10.1089/apc.2021.0020.
Despite widespread use of antiretroviral therapy (ART), people with HIV (PWH) continue to suffer substantial morbidity and mortality from pulmonary diseases. We sought to evaluate the prevalence of pulmonary symptoms, evaluations, and diagnoses (both infectious and noninfectious) among PWH receiving care at one of the largest HIV clinics in the United States. All PWH seen at the Infectious Disease Program in Atlanta, Georgia, from July 2013 to June 2018 were included. Multivariable logistic regression was used to assess the odds of all-cause mortality. Among 8387 patients, median age was 48 years, 35% had documented smoking, 74% were male, and the 47% with ≥1 pulmonary symptom or diagnosis were older and had higher rates of smoking compared to those without any symptoms or diagnoses (-values <0.0001). Percent on ART was 97% and 81% for individuals with and without symptoms or diagnoses, respectively (-value <0.0001). Patients with an infectious diagnosis were more likely to have a diagnostic test ordered than those with a noninfectious diagnosis (-value <0.0001). After adjustment for demographic and clinical risk factors, odds of death were 2.1 times greater [95% confidence interval (CI) = 1.3-3.5] among those with a pulmonary symptom or diagnosis compared to those without. Despite a high prevalence of pulmonary symptoms and diagnoses in this large cohort of PWH, many did not have a complete diagnostic evaluation, particularly those with noninfectious diagnoses. Greater awareness of evaluation and treatment of noninfectious pulmonary diseases among HIV care providers will be critical to improving long-term outcomes for PWH.
尽管广泛使用了抗逆转录病毒疗法（ART），但艾滋病毒感染者（PWH）仍因肺部疾病而遭受大量发病率和死亡率。我们试图评估在美国最大的艾滋病毒诊所之一接受治疗的 PWH 中肺部症状、评估和诊断（包括传染性和非传染性）的患病率。包括 2013 年 7 月至 2018 年 6 月在佐治亚州亚特兰大传染病项目就诊的所有 PWH。使用多变量逻辑回归评估全因死亡率的几率。在 8387 名患者中，中位年龄为 48 岁，35%有记录的吸烟史，74%为男性，有≥1 种肺部症状或诊断的 47%年龄较大，吸烟率也高于无任何症状或诊断的患者（P 值均<0.0001）。有症状或诊断的患者中接受 ART 的比例分别为 97%和 81%（P 值<0.0001）。与非传染性诊断相比，患有传染性诊断的患者更有可能接受诊断性检查（P 值<0.0001）。在校正了人口统计学和临床危险因素后，与无症状或无诊断的患者相比，有肺部症状或诊断的患者死亡的几率增加了 2.1 倍[95%置信区间（CI）=1.3-3.5]。尽管在这一大群 PWH 中肺部症状和诊断的患病率很高，但许多患者没有进行完整的诊断评估，尤其是那些患有非传染性诊断的患者。提高 HIV 护理提供者对非传染性肺部疾病评估和治疗的认识，对于改善 PWH 的长期预后至关重要。
