Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study.
Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study.
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DOI：
10.1136/bmjopen-2020-041734
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发表时间：
2021-01-08
期刊：
影响因子：
2.9
通讯作者：
Lima VD
中科院分区：
文献类型：
--
作者：
Nanditha NGA;Paiero A;Tafessu HM;St-Jean M;McLinden T;Justice AC;Kopec J;Montaner JSG;Hogg RS;Lima VD
随着艾滋病毒感染者（PLWH）寿命的延长，非艾滋病合并症的发病率和死亡率已成为主要关切问题。我们的目的是比较感染和不感染艾滋病毒的个体之间9种慢性年龄相关性合并症的患病趋势和诊断年龄。这项以人群为基础的队列研究使用了来自加拿大不列颠哥伦比亚省所有确诊的抗逆转录病毒治疗的PLWH和1：4年龄性别匹配的HIV阴性个体的纵向队列数据。该研究包括8031名抗逆转录病毒治疗的PLWH和32124名HIV阴性对照（中位年龄40岁，82%为男性）。合格受试者年龄≥19岁，在2000年至2012年期间随访≥1年。从省级行政数据库中确定了非艾滋病定义的癌症、糖尿病、骨关节炎、高血压、阿尔茨海默病和/或非艾滋病毒相关痴呆症、心血管、肾脏、肝脏和肺部疾病的存在。β回归评估了年度年龄-性别标准化患病率趋势，Kruskal-Wallis检验比较了按医疗保健就诊率分层的合并症诊断时的年龄。在整个研究期间，PLWH中除高血压外的所有慢性年龄相关合并症的患病率均高于社区HIV阴性患者;肝脏疾病的患病率高出10倍（25.3% vs 2.1%，p值<0.0001）。在按医疗保健就诊率分层时，PLWH经历了大多数与年龄相关的慢性疾病，显著早于HIV阴性对照组，早在阿尔茨海默病和/或痴呆症发生前21年。与HIV阴性对照组相比，PLWH的非艾滋病合并症患病率更高，诊断年龄更早。这些结果强调，需要在PLWH中早期对合并症进行优化筛查，并建立一个综合的艾滋病毒护理模式，将预防和治疗慢性年龄相关疾病相结合。此外，在这项研究中开发的强大的方法，解决了使用行政卫生数据来衡量患病率和发病率的问题，是可重复的其他设置。
As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV. This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada. The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012. The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters. Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia. PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.
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影响因子：
11.8
作者：
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DOI：
10.1080/09540121.2014.963012
发表时间：
2015-02-01
影响因子：
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作者：
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通讯作者：
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