Erlandson Kristine M, Fitch Kathleen V, McCallum Sara A, Ribaudo Heather J, Overton Edgar T, Zanni Markella V, Bloomfield Gerald S, Brown Todd T, Fichtenbaum Carl J, Bares Sara, Aberg Judith A, Douglas Pamela S, Fulda Evelynne S, Santana-Bagur Jorge L, Castro Jose G, Moran Laura E, Mave Vidya, Supparatpinyo Khuanchai, Ponatshego Ponego L, Schechter Mauro, Grinspoon Steven K
University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Clin Infect Dis. 2022 Sep 30;75(7):1154-1163. doi: 10.1093/cid/ciac098.
We sought to explore multinational differences in functional status by global burden of disease (GBD) regions in the REPRIEVE cohort.
REPRIEVE is a prospective, double-blind, randomized, placebo-controlled, multicenter, phase III primary cardiovascular prevention study of pitavastatin calcium vs placebo among people with human immunodeficiency virus (HIV, PWH) ages 40-75 on antiretroviral therapy (ART). GBD super regions were defined using World Health Organization classifications. Participants were categorized by impairment on the Duke Activity Status Instrument (DASI: none, some, moderate, severe). Logistic regression models examined risk factors and GBD regions associated with functional impairment. The association between functional impairment and cardiometabolic risk was also explored.
Of 7736 participants, the majority were from high-income countries (n = 4065), were male (65%), and had received ART for ≥ 10 years. The median DASI score was 58.2 (interquartile range [IQR] 50.2, 58.2); 36% reported at least some impairment. In adjusted analyses, functional impairment was significantly more frequent among participants from Southeast/East Asia. Other factors associated with greater impairment included female sex, Black race, older age, current/former smoking, higher body mass index, use of ART for ≥ 10 years, and select ART regimens; differences were seen in risks across GBD regions. Functional impairment was associated with increased cardiometabolic risk.
Over 1/3 of middle-aged and older PWH in a global cohort across diverse GBD regions demonstrate functional impairments. The associations between DASI and cardiometabolic risk suggest that a measure of functional status may improve risk prediction; these longitudinal associations will be further investigated over REPRIEVE trial follow-up.
我们试图通过REPRIEVE队列研究中全球疾病负担（GBD）区域来探讨功能状态的跨国差异。
REPRIEVE是一项前瞻性、双盲、随机、安慰剂对照、多中心的III期主要心血管预防研究，在年龄为40 - 75岁且正在接受抗逆转录病毒治疗（ART）的人类免疫缺陷病毒（HIV）感染者（PWH）中比较匹伐他汀钙与安慰剂。GBD超级区域是根据世界卫生组织的分类定义的。参与者根据杜克活动状态量表（DASI：无、有一些、中度、重度）的损伤情况进行分类。逻辑回归模型研究了与功能损伤相关的风险因素和GBD区域。还探讨了功能损伤与心脏代谢风险之间的关联。
在7736名参与者中，大多数来自高收入国家（n = 4065），为男性（65%），且接受ART治疗≥10年。DASI评分中位数为58.2（四分位间距[IQR] 50.2，58.2）；36%的人报告至少有一些损伤。在调整分析中，东南亚/东亚参与者的功能损伤明显更常见。与更大损伤相关的其他因素包括女性、黑人种族、年龄较大、当前/既往吸烟、较高的体重指数、接受ART治疗≥10年以及特定的ART方案；不同GBD区域的风险存在差异。功能损伤与心脏代谢风险增加相关。
在一个涵盖不同GBD区域的全球队列中，超过1/3的中老年PWH表现出功能损伤。DASI与心脏代谢风险之间的关联表明，功能状态的测量可能会改善风险预测；这些纵向关联将在REPRIEVE试验随访中进一步研究。
