Taborelli Martina, Suligoi Barbara, Serraino Diego, Frova Luisa, Grande Enrico, Toffolutti Federica, Regine Vincenza, Pappagallo Marilena, Pugliese Lucia, Grippo Francesco, Zucchetto Antonella
Cancer Epidemiology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
Centro Operativo AIDS, Istituto Superiore di Sanità, Roma, Italy.
BMJ Open. 2022 Dec 1;12(12):e064970. doi: 10.1136/bmjopen-2022-064970.
This study aimed to assess whether an excess mortality related to kidney and other urinary tract diseases exists among Italian people with AIDS (PWA), as compared with the general population without AIDS (non-PWA).
Population-based, retrospective cohort study.
We conducted a nationwide study including 9481 Italian PWA, aged 15-74 years, reported to the National AIDS Registry between 2006 and 2018.
Vital status and causes of death were retrieved by record linkage with the National Register of Causes of Death up to 2018. Excess mortality for PWA versus non-PWA was estimated through sex-standardised and age-standardised mortality ratios (SMRs) with corresponding 95% CIs.
Among 2613 deceased PWA, 262 (10.0%) reported at least one urinary tract disease at death, including 254 (9.7%) non-cancer diseases-mostly renal failures (225 cases, 8.6%)-and 9 cancers (0.3%). The overall SMR for non-cancer urinary tract diseases was 15.3 (95% CI 13.4 to 17.3) with statistically significant SMRs for acute (SMR=22.3, 95% CI 18.0 to 27.4), chronic (SMR=8.4, 95% CI 6.0 to 11.3), and unspecified renal failure (SMR=13.8, 95% CI 11.2 to 16.8). No statistically significant excess mortality was detected for urinary tract cancers (SMR=1.7, 95% CI 0.8 to 3.3). The SMRs were particularly elevated among PWA aged <50 years, injecting drug users, or those with the first HIV-positive test >6 months before AIDS diagnosis.
The excess mortality related to non-cancer kidney and other urinary tract diseases reported among PWA highlights the importance of implementing the recommendation for screening, diagnosis and management of such conditions among this population.
本研究旨在评估与未感染艾滋病的普通人群（非艾滋病患者）相比，意大利艾滋病患者（PWA）中是否存在与肾脏及其他泌尿系统疾病相关的超额死亡率。
基于人群的回顾性队列研究。
我们开展了一项全国性研究，纳入了9481名年龄在15 - 74岁之间、2006年至2018年期间向国家艾滋病登记处报告的意大利艾滋病患者。
通过与截至2018年的国家死亡原因登记处进行记录链接，获取生命状态和死亡原因。通过性别标准化和年龄标准化死亡率比（SMR）及相应的95%置信区间，估算艾滋病患者相对于非艾滋病患者的超额死亡率。
在2613名死亡的艾滋病患者中，262名（10.0%）在死亡时报告至少有一种泌尿系统疾病，其中包括254名（9.7%）非癌症疾病——主要是肾衰竭（225例，8.6%）——以及9例癌症（0.3%）。非癌症泌尿系统疾病的总体标准化死亡率比为15.3（95%置信区间13.4至17.3），急性（标准化死亡率比=22.3，95%置信区间18.0至27.4）、慢性（标准化死亡率比=8.4，95%置信区间6.至11.3）和未明确的肾衰竭（标准化死亡率比=13.8，95%置信区间11.2至16.8）的标准化死亡率比具有统计学意义。未检测到泌尿系统癌症的统计学显著超额死亡率（标准化死亡率比=）。在年龄小于50岁的艾滋病患者、注射吸毒者或艾滋病诊断前首次HIV检测呈阳性超过6个月的患者中，标准化死亡率比尤其升高。
艾滋病患者中报告的与非癌症肾脏及其他泌尿系统疾病相关的超额死亡率凸显了在该人群中实施此类疾病筛查、诊断和管理建议的重要性。
