The growing burden of noncommunicable disease among persons living with HIV in Zimbabwe.
The growing burden of noncommunicable disease among persons living with HIV in Zimbabwe.
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DOI：
10.1097/qad.0000000000001754
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发表时间：
2018-03-27
期刊：
影响因子：
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通讯作者：
Hallett TB
中科院分区：
文献类型：
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作者：
Smit M;Olney J;Ford NP;Vitoria M;Gregson S;Vassall A;Hallett TB
补充数字内容可在正文中获得我们的目标是描述津巴布韦未来的非传染性疾病(NCD)负担，以确定未来卫生系统的优先事项。我们为津巴布韦开发了一个基于个体的多疾病模型，模拟出生、死亡、感染艾滋病毒和进展以及关键的非传染性疾病[哮喘、慢性肾脏疾病(CKD)、抑郁症、糖尿病、高血压、中风、乳腺癌、宫颈癌、结直肠癌、肝癌、食道癌、前列腺癌和所有其他癌症]。该模型使用国家和区域监测和流行病学数据进行了参数化。编制了2015年至2035年的人口和非传染性疾病负担预测。该模型预测，2015年至2035年期间，艾滋病病毒携带者的平均年龄将从31岁增加到45岁(而未感染的人的平均年龄为20-26岁)。因此，到2035年，艾滋病患者中患上至少一种主要非传染性疾病的比例将增加26%，而在未感染的患者中，这一比例将增加6%。到2035年，与未感染的成年人相比，成人PLHIV感染至少一种关键非传染性疾病的可能性将增加一倍；所有关键非传染性疾病中有15.2%是成人PLHIV确诊的，而津巴布韦人口中只有5%。最常见的非传染性疾病将是高血压、慢性肾脏病、抑郁症和癌症。艾滋病病毒在人口和疾病方面的这种转变主要是因为发病率的减少和抗逆转录病毒疗法的成功推广导致了更长的预期寿命，其次是对艾滋病毒和抗逆转录病毒药物的累积暴露。非传染性疾病服务将需要在津巴布韦扩大。它们将需要被纳入艾滋病毒护理方案，尽管非传染性疾病在未感染者中的负担日益增加，这为艾滋病毒护理中发展的更多服务提供了机会，使艾滋病毒阴性者受益。
Supplemental Digital Content is available in the text We aim to characterize the future noncommunicable disease (NCD) burden in Zimbabwe to identify future health system priorities. We developed an individual-based multidisease model for Zimbabwe, simulating births, deaths, infection with HIV and progression and key NCD [asthma, chronic kidney disease (CKD), depression, diabetes, hypertension, stroke, breast, cervical, colorectal, liver, oesophageal, prostate and all other cancers]. The model was parameterized using national and regional surveillance and epidemiological data. Demographic and NCD burden projections were generated for 2015 to 2035. The model predicts that mean age of PLHIV will increase from 31 to 45 years between 2015 and 2035 (compared with 20–26 in uninfected individuals). Consequently, the proportion suffering from at least one key NCD in 2035 will increase by 26% in PLHIV and 6% in uninfected. Adult PLHIV will be twice as likely to suffer from at least one key NCD in 2035 compared with uninfected adults; with 15.2% of all key NCDs diagnosed in adult PLHIV, whereas contributing only 5% of the Zimbabwean population. The most prevalent NCDs will be hypertension, CKD, depression and cancers. This demographic and disease shift in PLHIV is mainly because of reductions in incidence and the success of ART scale-up leading to longer life expectancy, and to a lesser extent, the cumulative exposure to HIV and ART. NCD services will need to be expanded in Zimbabwe. They will need to be integrated into HIV care programmes, although the growing NCD burden amongst uninfected individuals presenting opportunities for additional services developed within HIV care to benefit HIV-negative persons.