Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population
Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population
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DOI：
10.1093/cid/cir627
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发表时间：
2011-12-01
影响因子：
11.8
通讯作者：
Palella, Frank
中科院分区：
文献类型：
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作者：
Guaraldi, Giovanni;Orlando, Gabriella;Palella, Frank
背景与普通人群相比，人类免疫缺陷病毒（HIV）感染患者发生非感染性合并症（NICM）的风险可能更高。我们在一个大型的HIV感染成人队列中评估了NICM的患病率和危险因素，并将这些发现与匹配的对照组数据进行了比较。我们进行了一项病例对照研究，涉及2002年至2009年在意大利摩德纳大学接受抗逆转录病毒治疗（ART）的HIV感染患者。将这些患者与CINECA ARNO数据库中一般人群中年龄、性别和种族匹配的成年人（对照受试者）进行比较。NICM包括心血管疾病、高血压、糖尿病、骨折和肾衰竭。多发性病变（Pp）定义为同时存在>= 2个NICM。建立Logistic回归模型以评估NICM和PP的相关预测因素。共有2854名患者和8562名对照受试者。平均年龄为46岁，其中37%为女性。在各年龄层中，患者的NICM和Pp患病率均高于对照组（均P <0.001）。年龄在41-50岁之间的患者的Pp患病率与年龄在51-60岁之间的对照组相似（P值无统计学意义）;在调整性别、年龄和高血压后，糖尿病、心血管疾病、骨折和肾衰竭在统计学上是独立的。Logistic回归模型显示，整个队列中Pp的独立预测因子为（所有P < .001）年龄（比值比[OR]，1.11）、男性（OR，1.77）、最低CD 4细胞计数< 200个细胞/lL（OR，4.46）和ART暴露（OR，1.01）。特定年龄相关的NICM和Pp在HIV感染患者中比在一般人群中更常见。艾滋病毒感染者的Pp患病率预期在一般人群中观察到的Pp患病率，其中年龄大于10岁的人，艾滋病毒特异性辅助因素（较低的最低CD 4细胞计数和更长时间的抗逆转录病毒治疗暴露）被确定为风险因素。这些数据支持需要对HIV感染者进行早期NICM筛查。
Background. Human immunodeficiency virus (HIV)-infected patients may have a greater risk of noninfectious comorbidities (NICMs) compared with the general population. We assessed the prevalence and risk factors for NICMs in a large cohort of HIV-infected adults and compared these findings with data from matched control subjects.Methods. We performed a case-control study involving antiretroviral therapy (ART)-experienced HIV-infected patients treated at Modena University, Italy, from 2002 through 2009. These patients were compared with age-, sex-, and race-matched adults (control subjects) from the general population included in the CINECA ARNO database. NICMs included cardiovascular disease, hypertension, diabetes mellitus, bone fractures, and renal failure. Polypathology (Pp) was defined as the concurrent presence of >= 2 NICMs. Logistic regression models were constructed to evaluate associated predictors of NICMs and Pp.Results. There were 2854 patients and 8562 control subjects. The mean age was 46 years, and 37% were women. Individual NICM and Pp prevalences in each age stratum were higher among patients than among controls (all P < .001). Pp prevalence among patients aged 41-50 years was similar to that among controls aged 51-60 years (P value was not statistically significant); diabetes mellitus, cardiovascular disease, bone fractures, and renal failure were statistically independent after adjustment for sex, age, and hypertension. Logistic regression models showed that independent predictors of Pp in the overall cohort were (all P < .001) age (odds ratio [OR], 1.11), male sex (OR, 1.77), nadir CD4 cell count < 200 cells/lL (OR, 4.46), and ART exposure (OR, 1.01).Conclusions. Specific age-related NICMs and Pp were more common among HIV-infected patients than in the general population. The prevalence of Pp in HIV-infected persons anticipated Pp prevalence observed in the general population among persons who were 10 years older, and HIV-specific cofactors (lower nadir CD4 cell count and more prolonged ART exposure) were identified as risk factors. These data support the need for earlier screening for NICMs in HIV-infected patients.