Is there an epidemic of HIV infection in the US ESRD program?
Is there an epidemic of HIV infection in the US ESRD program?
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DOI：
10.1097/01.asn.0000138546.53152.a7
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发表时间：
2004-09-01
影响因子：
13.6
通讯作者：
Kimmel, PL
中科院分区：
文献类型：
--
作者：
Eggers, PW;Kimmel, PL
调查显示，在20世纪80年代和90年代初，美国终末期肾病（ESRD）项目中HIV感染患者的患病率增加，聚集在25至44岁的年轻黑人男性中。自1996年高效抗逆转录病毒治疗问世以来，HIV感染患者的预后得到改善，治疗已被证明可改变经典HIV相关肾病的病程。我们使用美国肾脏数据系统数据库，通过主要诊断和共病艾滋病定义诊断，确定ESRD项目中HIV感染肾病患者的发病率和患病率是否增加。由于美国艾滋病患者人数从1995年的214，711人增加到2000年的337，017人，增加了57%，终末期肾病患者的发病人数从72，827人增加到94，602人，增加了29.9%，而艾滋病毒感染者的发病人数仅增加了3.5%，从1133人增加到1171人。在此期间，ESRD患者中HIV感染者的比例从1.56%下降到1.24%。从1995年到2000年，在25至44岁的黑人男性中，艾滋病毒感染占终末期肾病病例的比例从8.5%下降到6.2%。25至44岁的黑人男子艾滋病或艾滋病毒感染率从1995年的每百万人107例下降到2000年的每百万人78例。在ESRD项目中，感染艾滋病毒的妇女的发病率上升了14%，而男子的发病率下降了7%。近2000名艾滋病毒感染妇女（占人口的28.8%）已开始接受血液透析治疗终末期肾病。流行病例的绝对数量从2687例增加到4871例，增加了81.3%（占ESRD项目的0.90%到1.16%）。从1995年到2000年，HIV感染的ESRD患者的一年生存率从53.1%增加到67.1%。尽管由于保密问题和缺乏活检证实而导致的低报可能低估了这些值，但我们得出结论，尽管美国ESRD人群中HIV感染的患病率正在增加，作为该计划的一部分，增加是最小的，这是由于肾衰竭发展后的更好生存。美国ESRD项目中HIV感染的发病率是稳定的。高效抗逆转录病毒治疗可能是美国ESRD项目中HIV感染流行病学变化的原因。
Surveys revealed increases in the prevalence of HIV-infected patients in the US end-stage renal disease (ESRD) program in the 1980s and early 1990s, with clustering in young black men 25 to 44 yr old. Since the availability of highly active antiretroviral therapy in 1996, the prognosis of HIV-infected patients has improved, and therapy has been shown to change the course of classic HIV-associated nephropathy. We used the United States Renal Data System database to determine if the incidence and prevalence of HIV-infected patients with renal disease has increased in the ESRD program, by means of principal diagnoses and comorbid AIDS-defining diagnoses.As the number of US patients living with AIDS increased 57% from 214,711 in 1995 to 337,017 in 2000, and the number of incident ESRD patients increased 29.9% from 72,827 to 94,602, the number of incident HIV-infected patients increased only by 3.5%, from 1133 to 1171. Over this time, the percentage of incident ESRD patients with HIV infection fell from 1.56% to 1.24%. Among black men 25 to 44 yr of age, HIV infection as a proportion of incident ESRD cases fell from 8.5% to 6.2% from 1995 to 2000. The incident rate per million of AIDS or HIV infection in black men aged 25 to 44 fell from 107 in 1995 to 78 per million in 2000. The incidence rate for HIV-infected women in the ESRD program rose 14% while it declined 7% in men. Almost 2000 HIV-infected women, or 28.8% of the population, have initiated therapy for ESRD with hemodialysis. The number of prevalent cases increased in absolute numbers 81.3% from 2687 to 4871 (0.90% to 1.16% of the ESRD program). One-year survival rates for HIV-infected incident ESRD patients increased from 53.1% to 67.1% from 1995 to 2000.Although these values may be underestimates because of underreporting due to confidentiality concerns and lack of biopsy confirmation, we conclude that although the prevalence of HIV infection is increasing in the US ESRD population, the increase as a proportion of the program is minimal and is due to better survival after development of renal failure. The incidence of HIV infection in the US ESRD program is stable. Highly active antiretroviral therapy may be responsible for the change in epidemiology of HIV infection in the US ESRD program.