Skiest D J, Rubinstien E, Carley N, Gioiella L, Lyons R
University of Texas Southwestern Medical Center, Division of Infectious Diseases, Dallas 75235-9113, USA.
Am J Med. 1996 Dec;101(6):605-11. doi: 10.1016/S0002-9343(96)00329-4.
To study the impact of comorbidity on the course of HIV disease in older patients as compared to a matched cohort of younger patients.
In a retrospective case-control study, we compared 43 HIV-infected patients > 55 years old to a randomly selected cohort of 86 patients < 45 years old, matched by date of HIV diagnosis. We collected data on non-HIV-related morbidity (as assessed by the Charlson comorbidity index), initiator of HIV testing, HIV stage at time of HIV diagnosis (TOHD), AIDS defining diagnoses, AIDS-related illnesses (ARI), observed AIDS-free interval, survival, and frequency of HIV-related and unrelated hospitalizations.
The older cohort was more likely to have had HIV testing initiated by a health care provider (36 of 36 versus 50 of 66, P = 0.003), and to have acquired HIV from a transfusion (5 of 43 versus 0 of 86, P = 0.001), had lower CD4 cell counts at TOHD (205 versus 429, P = 0.02), a shorter observed AIDS-free interval (24.0 versus 52.8 months, P = 0.0002) and a shorter survival (28.2 versus 58.9 months, P = 0.0002). The older cohort had more HIV-related (13.4 versus 9.2 per 100 patient-months, P = 0.024) and non-HIV-related hospitalizations (12.9 versus 8.1 per 100 patient-months, P = 0.0001). The comorbidity index was significantly higher in the older cohort (0.907 versus 0.198, P = 0.0001) and was a strong predictor of mortality, independent of age group (risk ratio = 1.38 per comorbidity point, P = 0.0003).
Older HIV-infected patients presented with more advanced disease, which may have been due to lack of HIV awareness in this population. Older patients had a shorter observed AIDS-free interval and shorter survival. In addition, they had more HIV- and non-HIV-related comorbidity. The more rapid course and decreased survival in the elderly may be related to the increase in comorbidity.
与年龄匹配的年轻患者队列相比，研究合并症对老年HIV感染患者病程的影响。
在一项回顾性病例对照研究中，我们将43例年龄大于55岁的HIV感染患者与随机选择的86例年龄小于45岁的患者队列进行比较，两组按HIV诊断日期进行匹配。我们收集了以下数据：非HIV相关合并症（通过Charlson合并症指数评估）、HIV检测的发起者、HIV诊断时（TOHD）的HIV分期、AIDS定义诊断、AIDS相关疾病（ARI）、观察到的无AIDS间期、生存率以及HIV相关和非HIV相关住院的频率。
老年队列更有可能由医疗保健提供者发起HIV检测（36例中的36例 vs 66例中的50例，P = 0.003），并且更有可能通过输血感染HIV（43例中的5例 vs 86例中的0例，P = 0.001），在TOHD时CD4细胞计数较低（205 vs 429，P = 0.02），观察到的无AIDS间期较短（24.0个月 vs52.8个月，P = 0.0002），生存率较短（28.2个月 vs 58.9个月，P = 0.0002）。老年队列有更多的HIV相关住院（每100患者月13.4次 vs 9.2次，P =0.024）和非HIV相关住院（每100患者月12.9次 vs 8.1次，P = 0.0001）。老年队列的合并症指数显著更高（0.907 vs 0.198，P = 0.0001），并且是死亡率的强有力预测指标，与年龄组无关（每合并症点风险比 = 1.38，P = 0.0003）。
老年HIV感染患者呈现出更晚期的疾病，这可能是由于该人群对HIV缺乏认识所致。老年患者观察到的无AIDS间期较短，生存率较低。此外，他们有更多的HIV相关和非HIV相关合并症。老年人病程进展更快和生存率降低可能与合并症增加有关。
