Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Infectious Disease Clinic, Atlanta Veterans Affairs Medical Center, Decatur, GA; and.
J Acquir Immune Defic Syndr. 2023 Jan 1;92(1):17-26. doi: 10.1097/QAI.0000000000003107.
Causes of death and their trends among veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH.
The HIV Atlanta VA Cohort Study includes all VWH who ever sought care at the Atlanta VA Medical Center.
Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre-cART (1982-1996), early-cART (1997-2006), and late-cART (2007-2016) eras. Trends were assessed using Kaplan-Meier curves, cumulative incidence functions, and joinpoint regression models. Risk factors were identified by Cox proportional hazards models.
Of the 4674 VWH in the HIV Atlanta VA Cohort Study, 1752 died; of whom, 1399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-cART, early-cART, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non-AIDS-related mortality in the pre-cART era, followed by declines in the early-cART and late-cART eras. All-cause, AIDS-related, and non-AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre-cART to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non-AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV.
In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging but also intervene and address lifestyle risk factors.
艾滋病毒（HIV）感染者退伍军人（VWH）的死亡原因及其趋势与普通 HIV 感染者不同，但这尚未得到充分描述。本研究旨在了解在接受联合抗逆转录病毒治疗（cART）的不同时期，VWH 的全因和特定病因死亡率的趋势及其危险因素。
亚特兰大退伍军人事务部 HIV 队列研究包括所有曾在亚特兰大退伍军人事务部医疗中心寻求治疗的 VWH。
每年计算年龄调整后的全因和特定病因死亡率，并在 cART 前（1982-1996 年）、cART 早期（1997-2006 年）和 cART 晚期（2007-2016 年）时期进行比较。使用 Kaplan-Meier 曲线、累积发生率函数和联合回归模型评估趋势。使用 Cox 比例风险模型确定危险因素。
在 HIV 亚特兰大退伍军人事务部队列研究中的 4674 名 VWH 中，有 1752 人死亡；其中，1399 人（79.9%）、301 人（17.2%）和 52 人（3.0%）分别在 cART 前、早期和晚期被诊断出 HIV。在 cART 前时期，全因、艾滋病相关和非艾滋病相关死亡率显著增加，随后在 cART 早期和晚期时期下降。全因、艾滋病相关和非艾滋病相关死亡率分别从 cART 前时期下降了 65%、81%和 45%。然而，VWH 由于艾滋病相关感染、非艾滋病相关恶性肿瘤、呼吸疾病、心血管疾病和肾衰竭等原因，其死亡率仍高于普通 HIV 人群。
在年龄较大的 HIV 人群中，医生不仅要监测和治疗与衰老相关的疾病，还要干预和解决生活方式危险因素，这一点很重要。
