Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers
Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers
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DOI：
10.1177/0033354917748670
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发表时间：
2018-01-01
影响因子：
3.3
通讯作者：
McBurnie, Mary Ann
中科院分区：
文献类型：
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作者：
Mayer, Kenneth H.;Loo, Stephanie;McBurnie, Mary Ann
目标：随着人类免疫缺陷病毒 (HIV) 感染者预期寿命的延长，疾病谱也发生了变化。我们评估了在美国社区卫生中心接受初级保健的艾滋病毒感染者是否比在同一地点接受护理的未感染艾滋病毒的患者有更高的发病率。方法：我们比较了 12837 名艾滋病毒感染者和 227012 名未感染艾滋病毒患者的电子健康记录数据，以根据艾滋病毒血清状态评估糖尿病、高血压、慢性肾病、血脂异常和恶性肿瘤的相对患病率。我们使用多变量逻辑回归来评估差异。参与者是年龄≥18岁的患者，他们在社区卫生应用研究网络所属的17个社区卫生中心之一进行了≥3年的随访（从2006年1月至2016年12月）。结果：近三分之二的艾滋病毒感染者和未感染者生活在贫困中。与未感染 HIV 的患者相比，HIV 感染患者更容易被诊断和/或治疗糖尿病（比值比 [OR] = 1.18；95% 置信区间 [CI]，1.22-1.41）、高血压（OR = 1.38；95% CI，1.31-1.46）、血脂异常（OR = 2.30；95% CI， 2.17-2.43）、慢性肾病（OR = 4.75；95% CI，4.23-5.34）、淋巴瘤（OR = 4.02；95% CI，2.86-5.67）、与人乳头瘤病毒相关的癌症（OR = 5.05；95% CI，3.77-6.78）或其他癌症（OR = 1.25；95% CI，1.10-1.42）。 HIV感染者的卒中患病率（OR = 1.32；95% CI，1.06-1.63）高于未感染HIV的患者，但两组间心肌梗死或冠状动脉疾病的患病率没有差异。结论：随着HIV感染者的寿命延长，非传染性疾病负担的增加可能使他们的临床管理变得复杂，需要初级保健提供者接受针对该人群的慢性病管理培训。
Objectives: As the life expectancy of people infected with human immunodeficiency virus (HIV) infection has increased, the spectrum of illness has evolved. We evaluated whether people living with HIV accessing primary care in US community health centers had higher morbidity compared with HIV-uninfected patients receiving care at the same sites.Methods: We compared data from electronic health records for 12837 HIV-infected and 227012 HIV-uninfected patients to evaluate the relative prevalence of diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, and malignancies by HIV serostatus. We used multivariable logistic regression to evaluate differences. Participants were patients aged >= 18 who were followed for >= 3 years (from January 2006 to December 2016) in 1 of 17 community health centers belonging to the Community Health Applied Research Network.Results: Nearly two-thirds of HIV-infected and HIV-uninfected patients lived in poverty. Compared with HIV-uninfected patients, HIV-infected patients were significantly more likely to be diagnosed and/or treated for diabetes (odds ratio [OR] = 1.18; 95% confidence interval [CI], 1.22-1.41), hypertension (OR = 1.38; 95% CI, 1.31-1.46), dyslipidemia (OR = 2.30; 95% CI, 2.17-2.43), chronic kidney disease (OR = 4.75; 95% CI, 4.23-5.34), lymphomas (OR = 4.02; 95% CI, 2.86-5.67), cancers related to human papillomavirus (OR = 5.05; 95% CI, 3.77-6.78), or other cancers (OR = 1.25; 95% CI, 1.10-1.42). The prevalence of stroke was higher among HIV-infected patients (OR = 1.32; 95% CI, 1.06-1.63) than among HIV-uninfected patients, but the prevalence of myocardial infarction or coronary artery disease did not differ between the 2 groups.Conclusions: As HIV-infected patients live longer, the increasing burden of noncommunicable diseases may complicate their clinical management, requiring primary care providers to be trained in chronic disease management for this population.