Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA.
AIDS Res Hum Retroviruses. 2023 Dec;39(12):662-670. doi: 10.1089/AID.2022.0186. Epub 2023 Jul 27.
With the advancement of effective antiretroviral therapy, people with HIV live longer, and many are developing non-AIDS comorbidities. It is important to assess how comorbidities are associated with HIV-related health outcomes, such as viral suppression (VS). The aim of this study was to analyze the association between comorbidity burden, measured using a modified Quan-Charlson Comorbidity Index (QCCI), and VS (viral load result of <200 copies/mL). We hypothesized that an increase in QCCI score, indicating a higher risk for mortality, would correlate with lower likelihood of VS because of the burden of comorbidity treatment, possibly leading to worse antiretroviral adherence. Our analysis included participants from the DC Cohort Longitudinal HIV Study in Washington, DC. Eligible participants were aged ≥18 years and enrolled in the cohort as of January 1, 2018 ( = 2,471). A modified QCCI score, which weighs selected comorbidities (not including HIV/AIDS) and predicts mortality, was calculated using International Classification of Disease-9/10 codes from electronic health records. Multivariable logistic regressions were used to characterize the association between QCCI composite scores and VS. Participants were predominantly virally suppressed (89.6%), male (73.9%), non-Hispanic Black (74.7%), and between 18 and 55 years (59.3%). The median QCCI score was 1 (range = 1-12, interquartile range = 0-2), demonstrating predominately low mortality risk. We did not establish a statistically significant association between QCCI score and VS (adjusted odds ratio = 1.06, 95% confidence interval 0.96-1.17). Our findings suggest that a higher QCCI score was not associated with lower VS in this population, which may be partly due to the high retention in care among cohort participants.
随着有效的抗逆转录病毒疗法的进步,艾滋病毒感染者的寿命延长,许多人出现了非艾滋病合并症。评估合并症与艾滋病毒相关健康结果(如病毒抑制[VS])的关联非常重要。本研究旨在分析使用改良 Quan-Charlson 合并症指数(QCCI)衡量的合并症负担与 VS(病毒载量结果<200 拷贝/mL)之间的关联。我们假设 QCCI 评分的增加(表明死亡率风险增加)与 VS 的可能性降低相关,因为合并症治疗的负担可能导致抗逆转录病毒药物的依从性下降。
我们的分析包括来自华盛顿特区 DC 队列纵向艾滋病毒研究的参与者。合格的参与者年龄≥18 岁,截至 2018 年 1 月 1 日( = 2471 人)参加了该队列。使用电子健康记录中的国际疾病分类第 9/10 版代码计算改良的 QCCI 评分,该评分可衡量选定的合并症(不包括艾滋病毒/艾滋病)并预测死亡率。使用多变量逻辑回归来描述 QCCI 综合评分与 VS 之间的关联。参与者主要为病毒抑制(89.6%)、男性(73.9%)、非西班牙裔黑人(74.7%)和 18-55 岁(59.3%)。QCCI 评分中位数为 1(范围为 1-12,四分位距为 0-2),表明死亡率风险主要较低。我们没有发现 QCCI 评分与 VS 之间存在统计学上显著的关联(调整后的优势比 = 1.06,95%置信区间为 0.96-1.17)。
我们的研究结果表明,在该人群中,较高的 QCCI 评分与较低的 VS 无关,这可能部分归因于队列参与者的高保留率。
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