Antiretroviral treatment and age-related comorbidities in a cohort of older HIV-infected patients
Antiretroviral treatment and age-related comorbidities in a cohort of older HIV-infected patients
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DOI：
10.1111/j.1468-1293.2006.00420.x
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发表时间：
2006-11-01
期刊：
影响因子：
3
通讯作者：
Cargnel, A.
中科院分区：
文献类型：
--
作者：
Orlando, G.;Meraviglia, P.;Cargnel, A.
背景：随着多种治疗方法的出现，HIV感染已从威胁生命的疾病转变为慢性疾病。从老龄化和抗逆转录病毒疗法(ART)的累积效应来看，50岁的老年HIV感染患者构成了新的治疗挑战。方法比较1994年以来在意大利米兰的三个传染病科接受ART治疗48周的老年患者和25-35岁的年轻对照组的免疫病毒学效应和代谢相互作用。结果159名老年患者和118名对照在HIV分期、基线CD4细胞计数和病毒载量方面相似，但在HIV传播方式、合并疾病和相关慢性治疗方面存在差异。老年患者治疗48周后平均病毒载量下降2.6log(10)拷贝数/毫升，CD_4细胞数增加137.5个/亩L，而年轻对照组的免疫病毒学效应值与治疗前相似。老年患者检测异常的相对危险度(RR)分别为：血糖7.33[95%可信区间4.36~12.36]、总胆固醇1.73(95%可信区间1.45~2.07)、高密度脂蛋白胆固醇1.56(95%可信区间1.22~2.0)、甘油三酯1.26(95%可信区间1.02~1.56)、血肌酐6.48(95%可信区间4.36~9.66)。ALT为0.45(95%CI为0.35~0.58)。中老年患者出现中/重度肝肾毒性，而对照组则未见。老年患者和对照组对抗逆转录病毒治疗的耐受性没有差异。老年患者和对照组(P<；0.0001)分别诊断出3 9例新的心血管、内分泌代谢和神经痛性疾病(每百人年2 4.5 2例)和4例(每百人年3.39例)。结论抗逆转录病毒药物毒性引起的疾病或与之相关的疾病与年龄相关的健康状况相互作用，提出了新的问题和挑战。需要进行比较流行病学研究、针对具体问题的研究和监测，以回答临床监测中出现的问题。
Background The availability of several therapeutic regimens has transformed HIV infection from a life-threatening disease into a chronic condition. Older patients (> 50 years old) with HIV infection constitute a new treatment challenge in terms of the cumulative effects of ageing and antiretroviral therapy (ART).Methods The immunovirological effects and metabolic interactions of 48 weeks of ART in older patients followed up in three Infectious Diseases Units in Milan, Italy since 1994 were compared with those in younger controls aged 25-35 years.Results The 159 older patients and 118 controls enrolled in the study were comparable for HIV stage, baseline CD4 cell count and viral load but differed for mode of HIV transmission, comorbid conditions and related chronic treatments. Mean viral load decreased after 48 weeks of treatment by 2.6 log(10) HIV RNA copies/mL and CD4 count increased by 137.5 cells/mu L in older patients, and similar values for immunovirological effects were obtained in the young controls. The relative risk (RR) of an abnormal test in older patients was 7.33 [95% confidence interval (CI) 4.36-12.36] for glucose, 1.73 (95% CI 1.45-2.07) for total cholesterol, 1.56 (95% CI 1.22-2.0) for high-density lipoprotein cholesterol, 1.26 (95% CI 1.02-1.56) for triglycerides, 6.48 (95% CI 4.36-9.66) for serum creatinine, and 0.45 (95% CI 0.35-0.58) for ALT. Moderate/severe liver and renal toxicities were recorded in the older patients but not in the controls. The tolerability of ART did not differ between the older patients and the controls. Thirty-nine new cardiovascular, endocrine-metabolic and neuralgic disorders (24.52 per 100 person-years) were diagnosed in the older patients and four (3.39 per 100 person-years) in the controls (P < 0.0001).Conclusions Diseases induced by, or related to, the toxic effects of antiretrovirals interact with age-specific health profiles, raising new questions and challenges. Comparative epidemiological studies, research studies addressing specific questions and surveillance are needed to answer the questions that arise in clinical monitoring.