Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016.
Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016.
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DOI：
10.1097/qad.0000000000003134
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Silverberg MJ
中科院分区：
文献类型：
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作者：
Lam JO;Lee C;Gilsanz P;Hou CE;Leyden WA;Satre DD;Flamm JA;Towner WJ;Horberg MA;Silverberg MJ
为了通过HIV状态观察队列比较50岁后的痴呆症发病率和患病率，从2000年到2016年，从北加州、南加州和大西洋中部各州(马里兰州、弗吉尼亚州、华盛顿州)的Kaiser Permanente医疗系统确定了接受抗逆转录病毒治疗(ART)的HIV感染者(PWH)和人口统计学相似的非HIV感染者(PWoH)，他们都是50岁及以上。痴呆症的诊断来自电子健康记录。痴呆症的发病率和患病率，总体和按时间段分列(即2000年至2002年、2003年至2004年，…，2015-2016)，使用泊松回归计算。采用JOINPOINT回归分析趋势。比率被用来比较HIV感染情况下的痴呆症与社会人口学、物质使用和临床因素的调整。这项研究包括13,296名PWH和155,354名PWoH(基线：两者的平均年龄=54岁，男性89%；PWH患者，80%携带HIV RNA；200拷贝/毫升)。从2000年到2016年，威斯康星医院的痴呆总发病率较高(调整后的发病率比[aIRR]=1.80，95%CI=1.60-2.04)。威尔斯亲王医院和妇幼保健院的痴呆症发病率均有所下降(−分别为8.0%和3.1%)，但在最近的2015年至2016年期间，威尔斯亲王医院的痴呆症发病率仍然较高(−=1.58，95%CI=1.18-2.12)。威尔斯亲王医院2000-2016年痴呆总患病率较高(调整后患病率[APR]=1.86，95%CI=1.70-2.04)，2015-2016年威尔斯亲王医院痴呆症总患病率较高(APR=1.75，95%CI=1.56-1.97)。痴呆症发病率的下降是令人鼓舞的，可能反映了ART的改善，但PWH仍然比PWoH更有可能患有痴呆症。随着人口老龄化，监测PWH中痴呆症的负担是重要的。
To compare dementia incidence and prevalence after age 50 by HIV status Observational cohort, 2000 to 2016 People with HIV (PWH) on antiretroviral therapy (ART) and demographically-similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser Permanente healthcare systems in Northern California, Southern California, and Mid-Atlantic States (Maryland, Virginia, Washington D.C.). Dementia diagnoses were obtained from electronic health records. Incidence and prevalence of dementia, overall and by time period (i.e., 2000–2002, 2003–2004, …, 2015–2016), were calculated using Poisson regression. Trends were examined using Joinpoint regression. Rate ratios were used to compare dementia by HIV status with adjustment for sociodemographics, substance use, and clinical factors. The study included 13,296 PWH and 155,354 PWoH (at baseline: for both, mean age=54 years, 89% male; for PWH, 80% with HIV RNA <200 copies/ml). From 2000 to 2016, overall incidence of dementia was higher among PWH (adjusted incidence rate ratio [aIRR]=1.80, 95% CI=1.60–2.04). Dementia incidence decreased among both PWH and PWoH (−8.0% and −3.1% per period, respectively), but remained higher among PWH in the most recent time period, 2015–2016 (aIRR=1.58, 95% CI=1.18–2.12). The overall prevalence of dementia from 2000–2016 was higher among PWH (adjusted prevalence ratio [aPR]=1.86, 95% CI=1.70–2.04) and was also higher among PWH in 2015–2016 (aPR=1.75, 95% CI=1.56–1.97). Reductions in dementia incidence are encouraging and may reflect ART improvement, but PWH are still more likely to have dementia than PWoH. Monitoring the burden of dementia among PWH is important as this population ages.