Comparison of Risk and Age at Diagnosis of Myocardial Infarction, End-Stage Renal Disease, and Non-AIDS-Defining Cancer in HIV-Infected Versus Uninfected Adults
Comparison of Risk and Age at Diagnosis of Myocardial Infarction, End-Stage Renal Disease, and Non-AIDS-Defining Cancer in HIV-Infected Versus Uninfected Adults
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DOI：
10.1093/cid/ciu869
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发表时间：
2015-02-15
影响因子：
11.8
通讯作者：
Justice, Amy C.
中科院分区：
文献类型：
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作者：
Althoff, Keri N.;McGinnis, Kathleen A.;Justice, Amy C.
背景虽然已经表明，人类免疫缺陷病毒（HIV）感染的成年人发生衰老相关事件的风险更大，但仍不清楚这些事件是否发生在与未感染的成年人相似或更年轻的年龄。本研究的目的是比较HIV感染者和人口统计学上相似的未感染者中3种年龄相关疾病的中位年龄和发病风险。这项研究是嵌套在临床前瞻性退伍军人老龄化队列研究的艾滋病毒感染和人口统计学匹配的未感染的退伍军人，从2003年4月1日至2010年12月31日。结果为心肌梗死（MI）、终末期肾病（ESRD）和非AIDS定义癌症（NADC）的有效诊断。分别使用多元线性回归模型和考克斯比例风险模型估计平均诊断年龄和诊断风险的差异。共有98687名（31%的HIV感染者和69%的未感染者）成人贡献了> 450000人年和689名MI、1135名ESRD和4179名NADC事件诊断。MI时的平均年龄（校正后的平均差异，-0.11; 95%置信区间[CI]，-0.59至0.37岁）和NADC时的平均年龄（校正后的平均差异，-0.10 [95% CI，-0.30至0.10]岁）在HIV状态方面没有差异。HIV感染的成年人被诊断为ESRD的平均年龄比未感染的成年人小5.5个月（校正的平均差异，-0.46 [95%CI，-0.86至-0.07]岁）。在考虑了重要的混杂因素后，与未感染的成年人相比，HIV感染的成年人发生所有3种结局的风险更大。感染艾滋病毒的成年人发生这些年龄相关事件的风险更高，但它们发生在与未感染艾滋病毒的成年人相似的年龄。
Background. Although it has been shown that human immunodeficiency virus (HIV)-infected adults are at greater risk for aging-associated events, it remains unclear as to whether these events happen at similar, or younger ages, in HIV-infected compared with uninfected adults. The objective of this study was to compare the median age at, and risk of, incident diagnosis of 3 age-associated diseases in HIV-infected and demographically similar uninfected adults.Methods. The study was nested in the clinical prospective Veterans Aging Cohort Study of HIV-infected and demographically matched uninfected veterans, from 1 April 2003 to 31 December 2010. The outcomes were validated diagnoses of myocardial infarction (MI), end-stage renal disease (ESRD), and non-AIDS-defining cancer (NADC). Differences in mean age at, and risk of, diagnosis by HIV status were estimated using multivariate linear regression models and Cox proportional hazards models, respectively.Results. A total of 98 687 (31% HIV-infected and 69% uninfected) adults contributed >450 000 person-years and 689 MI, 1135 ESRD, and 4179 NADC incident diagnoses. Mean age at MI (adjusted mean difference, -0.11; 95% confidence interval [CI], -.59 to .37 years) and NADC (adjusted mean difference, -0.10 [95% CI, -.30 to .10] years) did not differ by HIV status. HIV-infected adults were diagnosed with ESRD at an average age of 5.5 months younger than uninfected adults (adjusted mean difference, -0.46 [95% CI, -.86 to -.07] years). HIV-infected adults had a greater risk of all 3 outcomes compared with uninfected adults after accounting for important confounders.Conclusions. HIV-infected adults had a higher risk of these age-associated events, but they occurred at similar ages than those without HIV.