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HIV 感染者中,年龄相关疾病的发病率高,但导致认知障碍的高级神经病变发病率低:一项数据链接 10 年随访研究。

Low incidence of advanced neurological burden but high incidence of age-related conditions that are dementia risk factors in aging people living with HIV: a data-linkage 10-year follow-up study.

机构信息

Departments of Neurology and HIV Medicine, St. Vincent's Hospital and Peter Duncan Neurosciences Unit, St. Vincent's Centre for Applied Medical Research, Sydney, Australia.

Faculty of Medicine, UNSW, Sydney, Australia.

出版信息

J Neurovirol. 2023 Apr;29(2):141-155. doi: 10.1007/s13365-022-01104-0. Epub 2022 Dec 12.

Abstract

Although increasing research is focusing on age-related comorbidities (ARC) among people living with HIV (PLHIV), no studies have concomitantly assessed non-HIV age-related neurological disorders (e.g., Alzheimer's dementia). A total of 254 PLHIV and 69 HIV-negative controls completed baseline medical history and cognitive testing. ARC data were collected from medical records over the subsequent 9-10 years and included all types of strokes, all types of dementia, mild cognitive impairment, Parkinson's disease, motor neuron disease (grouped into a non-HIV age-related neurological category), cardiovascular disease, chronic kidney disease, chronic liver disease, chronic lung disease, non-AIDS cancers, osteoporosis, and diabetes. Kaplan-Meier curves assessed differences in the incident rates (per 1000 person year) of groups of ARC as defined above and combined ARC (i.e., development of any of the ARC) among younger (baseline age < 50) and older (baseline age ≥ 50) PLHIV and younger and older controls. Cox-proportional hazard models assessed the individual and interaction effects of HIV status and chronological age, in addition to a range of demographic and clinical variables including historical and baseline HIV brain involvement on the risk of developing combined ARC. Older PLHIV had a higher incidence of cardiovascular disease, osteoporosis, and combined ARC compared to other groups (p < 0.05). Incident rate of non-HIV age-related neurological disorders was 2.3 [0.93, 4.79] per 1000 person year. While this incident rate was higher in older PLHIV (5.37 [1.97, 11.92]) than older HIV-negative participants (3.58 [0.18-17.67]), this was not significant. In multivariate analyses, HIV status and chronological age, but not their interaction, and smoking were associated with higher risk of combined ARC (p < 0.05). In analyses focusing on PLHIV, older age and taking abacavir/efavirenz/atazanavir/darunavir containing antiretroviral treatments at the time of diagnosis were associated with greater ARC (p < 0.05). Non-HIV age-related neurological disorders are uncommon in older PLHIV, where the majority were < 70 years of age at the end of follow-up. However, the greater burden of ARC among older PLHIV, most of which are established dementia risk factors, warrants the establishment of commensurate prevention strategies and greater attention to neurocognitive screening.

摘要

尽管越来越多的研究关注与艾滋病毒感染者 (PLHIV) 相关的年龄相关合并症 (ARC),但尚无研究同时评估非艾滋病毒相关的年龄相关神经退行性疾病 (如阿尔茨海默病痴呆)。共有 254 名 PLHIV 和 69 名 HIV 阴性对照者完成了基线病史和认知测试。ARC 数据通过后续 9-10 年的医疗记录收集,包括所有类型的中风、所有类型的痴呆、轻度认知障碍、帕金森病、运动神经元病 (归入非 HIV 相关的神经退行性疾病类别)、心血管疾病、慢性肾病、慢性肝病、慢性肺病、非艾滋病癌症、骨质疏松症和糖尿病。 Kaplan-Meier 曲线评估了年龄较小 (基线年龄 < 50 岁) 和年龄较大 (基线年龄 ≥ 50 岁) PLHIV 以及年龄较小和较大对照组中上述定义的 ARC 组的发生率 (每 1000 人年) 以及合并 ARC(即出现任何 ARC)的差异。 Cox 比例风险模型评估了 HIV 状态和实际年龄的个体和交互作用,以及一系列人口统计学和临床变量,包括历史和基线 HIV 大脑受累对发生合并 ARC 的风险的影响。与其他组相比,老年 PLHIV 心血管疾病、骨质疏松症和合并 ARC 的发病率更高 (p < 0.05)。非 HIV 相关的年龄相关神经退行性疾病的发生率为每 1000 人年 2.3 [0.93, 4.79]。虽然老年 PLHIV 的这一发病率 (5.37 [1.97, 11.92]) 高于老年 HIV 阴性参与者 (3.58 [0.18-17.67]),但无统计学意义。在多变量分析中,HIV 状态和实际年龄,但不是它们的相互作用,以及吸烟与合并 ARC 的风险增加相关 (p < 0.05)。在针对 PLHIV 的分析中,年龄较大以及在诊断时接受包含阿巴卡韦/依非韦伦/阿扎那韦/达芦那韦的抗逆转录病毒治疗与更大的 ARC 相关 (p < 0.05)。在随访结束时年龄较大的 PLHIV 中,非 HIV 相关的年龄相关神经退行性疾病并不常见,大多数年龄小于 70 岁。然而,年龄较大的 PLHIV 中 ARC 的负担更大,其中大多数是已确立的痴呆危险因素,这需要制定相应的预防策略,并更加关注神经认知筛查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f50f/10185650/76f705633ba9/13365_2022_1104_Fig1_HTML.jpg

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