Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997-2019.
Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997-2019.
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DOI：
10.1093/ofid/ofac702
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发表时间：
2023-02
影响因子：
4.2
通讯作者：
中科院分区：
文献类型：
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作者：
为了评估累积性人类免疫缺陷病毒（HIV）-1病毒血症对HIV感染女性（WWH）中与衰老相关的多发病的影响，我们分析了在抗逆转录病毒治疗（ART）开始后（1997-2019）实现病毒抑制的女性中前瞻性收集的数据。我们纳入了自我报告的ART使用后2年内（基线）≥2个血浆HIV-1病毒载量（VL）<200拷贝/mL的WWH。 主要结局为多发病（共评估5例非获得性免疫缺陷综合征合并症[NACM] ≥ 2例）。梯形法则计算病毒血症拷贝年（VCY）作为VL曲线下面积。考克斯比例风险模型估计了时间更新的累积VCY与事件多发性骨髓瘤和每种NACM发生率的相关性，调整了重要的协变量（例如，年龄，CD 4计数等）。806名WWH参与者贡献了6368名女性-年，每位参与者的平均VL为12（Q1-Q3，7-23）。基线时，中位年龄为39岁，56%为黑人，中位CD 4为534个细胞/mm 3。中位时间更新累积VCY为5.4（Q1-Q3，4.7-6.9）log 10拷贝-年/mL。在211例（26%）发生多发性硬化的WWH中，162例（77%）有高血压事件，133例（63%）有血脂异常，60例（28%）有糖尿病，52例（25%）有心血管疾病，32例（15%）有肾脏疾病。与时间更新累积VCY <5 log 10的WWH患者相比，VCY 5-6.9和≥7 log 10拷贝年/mL的患者的校正后多死亡风险比分别为1.99（95%置信区间[CI]，1.29-3.08）和3.78（95% CI，2.17-6.58）（P < .0001）。较高的时间更新累积VCY增加了每种NACM的风险。在ART治疗的WWH中，更大的累积病毒血症增加了多发病和发生每种NACM的风险，因此这可能是该人群中NACM风险评估的一个临床有用的生物标志物。在接受ART治疗后前瞻性随访的HIV感染女性中，累积病毒血症增加了多发病的风险，并增加了每种非AIDS合并症的发生率;因此，它可能是该人群合并症风险评估的一个实用生物标志物。
To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997–2019). We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc). Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1–Q3, 7–23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm3. Median time-updated cumulative VCY was 5.4 (Q1–Q3, 4.7–6.9) log10 copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log10, the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29–3.08) and 3.78 (95% CI, 2.17–6.58) for those with VCY 5–6.9 and ≥7 log10 copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM. Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population. Among women with HIV prospectively followed after ART initiation, greater cumulative viremia increased the risk of multimorbidity and incidence of each non-AIDS comorbidity assessed; and hence it may be a prognostically useful biomarker for comorbidity risk assessment in this population.
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影响因子：
4.2
作者：
Castillo-Mancilla, Jose R.;Brown, Todd T.;Wada, Nikolas I.
通讯作者：
Wada, Nikolas I.
影响因子：
11.8
作者：
Guaraldi, Giovanni;Orlando, Gabriella;Palella, Frank
通讯作者：
Palella, Frank
影响因子：
3.7
作者：
Grund B;Baker JV;Deeks SG;Wolfson J;Wentworth D;Cozzi-Lepri A;Cohen CJ;Phillips A;Lundgren JD;Neaton JD;INSIGHT SMART/ESPRIT/SILCAAT Study Group
通讯作者：
INSIGHT SMART/ESPRIT/SILCAAT Study Group
影响因子：
4.2
作者：
Castillo-Mancilla JR;Morrow M;Coyle RP;Coleman SS;Zheng JH;Ellison L;Bushman LR;Kiser JJ;Anderson PL;MaWhinney S
通讯作者：
MaWhinney S
影响因子：
4.6
作者：
Achhra AC;Lyass A;Borowsky L;Bogorodskaya M;Plutzky J;Massaro JM;D'Agostino RB Sr;Triant VA
通讯作者：
Triant VA