Future challenges for clinical care of an ageing population infected with HIV: a modelling study.
Future challenges for clinical care of an ageing population infected with HIV: a modelling study.
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DOI：
10.1016/s1473-3099(15)00056-0
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
ATHENA observational cohort
中科院分区：
文献类型：
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作者：
Smit M;Brinkman K;Geerlings S;Smit C;Thyagarajan K;Sighem Av;de Wolf F;Hallett TB;ATHENA observational cohort
感染艾滋病毒的人口正在老龄化，这些人将越来越多地患上与年龄相关的非传染性疾病(NCDs)。我们的目标是量化这一变化的规模及其对荷兰未来艾滋病毒护理的影响。我们构建了一个基于个体的艾滋病毒感染人群模型，跟踪患者随着年龄的增长接受艾滋病毒治疗，患上非传染性疾病-包括心血管疾病(高血压、高胆固醇血症、心肌梗死和中风)、糖尿病、慢性肾脏疾病、骨质疏松症和非艾滋病恶性肿瘤-并开始对这些疾病进行联合药物治疗。该模型是通过使用1996年至2010年荷兰国家雅典娜队列中10名 278名患者的数据进行参数化的。我们做出了到2030年的预测。我们的模型表明，接受联合抗逆转录病毒疗法(ART)的艾滋病毒感染患者的中位年龄将从2010年的43.9岁增加到2030年的56.6岁，其中50岁或以上的艾滋病毒感染患者的比例将从2010年的28%增加到2030年的73%。我们预测，到2030年，84%的艾滋病毒感染患者将至少患有一种非传染性疾病，高于2010年的29%，到2030年，28%的艾滋病毒感染患者将患有三种或更多非传染性疾病。到2030年，54%的艾滋病毒感染患者将服用联合用药，而2010年这一比例为13%，其中20%的患者将服用三种或更多联合用药。这一变化的大部分将由心血管疾病和相关药物的日益流行推动。由于禁忌症和药物-药物相互作用，到2030年，40%的患者可能会出现目前推荐的一线艾滋病毒方案的并发症。荷兰感染艾滋病毒的患者的情况正在发生变化，患有多种疾病的老年患者数量不断增加。这些变化意味着，在不久的将来，除了循证筛查和监测方案外，艾滋病毒护理将越来越需要利用广泛的医学学科，以确保持续的高质量护理。这些发现是基于荷兰艾滋病毒感染患者的大型数据集，但我们相信，总体模式将在欧洲和北美其他地方重复。这一趋势对非洲高负担国家艾滋病毒感染者的护理可能带来特别的挑战。医学研究理事会、比尔和梅林达·盖茨基金会、拉什基金会以及荷兰卫生、福利和体育部。
The population infected with HIV is getting older and these people will increasingly develop age-related non-communicable diseases (NCDs). We aimed to quantify the scale of the change and the implications for HIV care in the Netherlands in the future. We constructed an individual-based model of the ageing HIV-infected population, which followed patients on HIV treatment as they age, develop NCDs—including cardiovascular disease (hypertension, hypercholesterolaemia, myocardial infarctions, and strokes), diabetes, chronic kidney disease, osteoporosis, and non-AIDS malignancies—and start co-medication for these diseases. The model was parameterised by use of data for 10 278 patients from the national Dutch ATHENA cohort between 1996 and 2010. We made projections up to 2030. Our model suggests that the median age of HIV-infected patients on combination antiretroviral therapy (ART) will increase from 43·9 years in 2010 to 56·6 in 2030, with the proportion of HIV-infected patients aged 50 years or older increasing from 28% in 2010 to 73% in 2030. In 2030, we predict that 84% of HIV-infected patients will have at least one NCD, up from 29% in 2010, with 28% of HIV-infected patients in 2030 having three or more NCDs. 54% of HIV-infected patients will be prescribed co-medications in 2030, compared with 13% in 2010, with 20% taking three or more co-medications. Most of this change will be driven by increasing prevalence of cardiovascular disease and associated drugs. Because of contraindications and drug–drug interactions, in 2030, 40% of patients could have complications with the currently recommended first-line HIV regimens. The profile of patients in the Netherlands infected with HIV is changing, with increasing numbers of older patients with multiple morbidities. These changes mean that, in the near future, HIV care will increasingly need to draw on a wide range of medical disciplines, in addition to evidence-based screening and monitoring protocols to ensure continued high-quality care. These findings are based on a large dataset of HIV-infected patients in the Netherlands, but we believe that the overall patterns will be repeated elsewhere in Europe and North America. The implications of such a trend for care of HIV-infected patients in high-burden countries in Africa could present a particular challenge. Medical Research Council, Bill & Melinda Gates Foundation, Rush Foundation, and Netherlands Ministry of Health, Welfare and Sport.