感染与未感染艾滋病毒人群中慢性合并症相关的伤残调整生命年：加拿大不列颠哥伦比亚省健康负担评估

Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada.

作者信息

Nanditha Ni Gusti Ayu, Zhu Jielin, Wang Lu, Kopec Jacek, Hogg Robert S, Montaner Julio S G, Lima Viviane D

机构信息

British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada.

Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

出版信息

PLOS Glob Public Health. 2022 Oct 14;2(10):e0001138. doi: 10.1371/journal.pgph.0001138. eCollection 2022.

DOI:10.1371/journal.pgph.0001138

PMID:36962693

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10021313/

Abstract

Life span of people living with HIV (PLWH) has increased dramatically with the advent of modern antiretroviral therapy. As a result, comorbidities have emerged as a significant concern in this population. To describe the burden of chronic comorbidities among PLWH and HIV-negative individuals in British Columbia (BC), Canada, we estimated disability-adjusted life years (DALYs) related to these comorbidities. Based on a population-based cohort in BC, antiretroviral-treated adult PLWH and 1:4 age-sex-matched HIV-negative controls were followed for ≥1 year during 2001-2012. DALYs combined years of life lost to premature mortality (YLLs) and due to disability (YLDs), and were estimated following the Global Burden of Diseases' approaches. DALYs associated with non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, dementia, cardiovascular (CVD), kidney, liver and chronic obstructive pulmonary diseases were each measured for 2008-2012. Among PLWH, DALYs attributed to non-AIDS-related cancers were also estimated for 2013-2020. We observed that at baseline, our matched cohort consisted of 82% males with a median age of 40 years (25th-75th percentiles: 34-47). During 2008-2012, 7042 PLWH and 30,640 HIV-negative individuals were alive, where PLWH experienced a twofold higher DALYs associated with chronic comorbidities (770.2 years/1000 people [95% credible intervals: 710.2, 831.6] vs. 359.0 [336.0, 382.2]). Non-AIDS-defining cancers and CVD contributed the highest DALYs in both populations, driven by YLLs rather than YLDs. Among PLWH, we estimated increasing DALYs attributable to non-AIDS-defining cancers with 91.7 years/1000 people (77.4, 106.0) in 2013 vs. 97.6 (81.0, 115.2) in 2020. In this study, we showed that PLWH experience a disproportionate burden of chronic comorbidities compared to HIV-negative individuals. The observed disparities may relate to differential health behaviors, residual HIV-related inflammation, and ART-related toxicities. As aging shapes future healthcare needs, our findings highlight the need to enhance prevention and management of comorbidities as part of HIV care.

摘要

随着现代抗逆转录病毒疗法的出现，艾滋病毒感染者（PLWH）的寿命显著延长。因此，合并症已成为这一人群的一个重大问题。为了描述加拿大不列颠哥伦比亚省（BC）PLWH和艾滋病毒阴性个体中慢性合并症的负担，我们估算了与这些合并症相关的残疾调整生命年（DALYs）。基于BC省的一个人群队列，在2001年至2012年期间，对接受抗逆转录病毒治疗的成年PLWH和1:4年龄性别匹配的艾滋病毒阴性对照进行了≥1年的随访。DALYs综合了因过早死亡而损失的生命年数（YLLs）和因残疾而损失的生命年数（YLDs），并按照全球疾病负担的方法进行估算。对2008年至2012年期间与非艾滋病定义癌症、糖尿病、骨关节炎、高血压、痴呆症、心血管疾病（CVD）、肾脏疾病、肝脏疾病和慢性阻塞性肺疾病相关的DALYs分别进行了测量。在PLWH中，还估算了2013年至2020年期间归因于非艾滋病相关癌症的DALYs。我们观察到，在基线时，我们的匹配队列由82%的男性组成，中位年龄为40岁（第25至75百分位数：34至47岁）。在2008年至2012年期间，7042名PLWH和30640名艾滋病毒阴性个体存活，其中PLWH因慢性合并症而经历的DALYs高出两倍（770.2年/1000人[95%可信区间：710.2，831.6]，而艾滋病毒阴性个体为359.0[336.0，382.2]）。在这两个人群中，非艾滋病定义癌症和CVD导致的DALYs最高，主要由YLLs而非YLDs驱动。在PLWH中，我们估计2013年归因于非艾滋病定义癌症的DALYs为91.7年/1000人（77.4，106.0），2020年为97.6（81.0，115.2）。在本研究中，我们表明与艾滋病毒阴性个体相比，PLWH承受着不成比例的慢性合并症负担。观察到的差异可能与不同的健康行为、残留的艾滋病毒相关炎症以及抗逆转录病毒疗法相关的毒性有关。随着老龄化塑造未来的医疗保健需求，我们的研究结果强调了作为艾滋病毒护理的一部分，加强合并症预防和管理的必要性。