An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
An expanding HIV epidemic among older adults in Ukraine: Implications for patient-centered care.
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DOI：
10.1371/journal.pone.0256627
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Shenoi SV
中科院分区：
文献类型：
--
作者：
Rozanova J;Zeziulin O;Rich KM;Altice FL;Kiriazova T;Zaviryukha I;Sosidko T;Gulati K;Carroll C;Shenoi SV
东欧和中亚地区是全球艾滋病毒发病率和死亡率增幅最高的地区，艾滋病毒的治疗和预防效果欠佳。所有欧亚经济共同体国家(除俄罗斯外)都是中低收入国家。虽然LMIC是所有老年艾滋病毒携带者(定义为≥50岁)的80%的人的家园，但现有文献观察到，与所有其他全球区域相比，新诊断的OPWH在EECA中所占比例最低。我们检查了乌克兰OPWH的艾滋病毒诊断，乌克兰是EECA区域的象征。我们分析了2015年至2018年的艾滋病毒确诊事件和2016年至2018年的死亡趋势，分三个年龄段：1)15-24岁；2)25-49岁；3)≥50岁。艾滋病定义为CD_4~200细胞/毫升。死亡率被定义为同一日历年内每1000名新诊断的艾滋病毒患者中的死亡人数。计算了2016、2017和2018年的死亡率，并与年龄匹配的一般人口死亡率进行了比较，并计算了全因标准化死亡率(SMR)。从2015-2018年，OPWH每年被诊断为艾滋病毒感染者的比例从11.2%上升到14.9%(p<；0.01)。在确诊时，OPWH患艾滋病的可能性(43.8%)也显著高于25-49岁(29.5%)和15-24岁(13.3%)。在乌克兰普通人群中，新诊断的OPWH的同年死亡率比年龄匹配的人群高3至8倍。这些发现表明，需要重新评估乌克兰的艾滋病毒检测、预防和治疗战略，以使OPWH成为关注的焦点。OPWH更有可能感染晚期艾滋病毒，死亡率更高。重新设计检测实践尤其重要，因为OPWH没有参加有针对性的检测计划，而且随着它们出现定义艾滋病的症状而越来越多地被诊断出来。链接和治疗方案的新战略应反映这一目标人群的不同需求。
The Eastern Europe and Central Asian (EECA) region has the highest increase in HIV incidence and mortality globally, with suboptimal HIV treatment and prevention. All EECA countries (except Russia) are low and middle-income (LMIC). While LMIC are home to 80% of all older people living with HIV (OPWH), defined as ≥50 years, extant literature observed that newly diagnosed OPWH represent the lowest proportion in EECA relative to all other global regions. We examined HIV diagnoses in OPWH in Ukraine, a country emblematic of the EECA region. We analysed incident HIV diagnoses from 2015–2018 and mortality trends from 2016–2018 for three age groups: 1) 15–24 years; 2) 25–49 years; and 3) ≥50 years. AIDS was defined as CD4<200cells/mL. Mortality was defined as deaths per 1000 patients newly diagnosed with HIV within the same calendar year. Mortality rates were calculated for 2016, 2017, and 2018, compared to age-matched general population rates, and all-cause standardized mortality ratios (SMRs) were calculated. From 2015–2018, the proportion of OPWH annually diagnosed with HIV increased from 11.2% to 14.9% (p<0.01). At the time of diagnosis, OPWH were also significantly (p<0.01) more likely to have AIDS (43.8%) than those aged 25–49 years (29.5%) and 15–24 years (13.3%). Newly diagnosed OPWH had the same-year mortality ranging from 3 to 8 times higher than age-matched groups in the Ukrainian general population. These findings suggest a reassessment of HIV testing, prevention and treatment strategies in Ukraine is needed to bring OPWH into focus. OPWH are more likely to present with late-stage HIV and have higher mortality rates. Re-designing testing practices is especially crucial since OPWH are absent from targeted testing programs and are increasingly diagnosed as they present with AIDS-defining symptoms. New strategies for linkage and treatment programs should reflect the distinct needs of this target population.
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