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Professor
Division of HIV/AIDS Treatment and Care
National Center for AIDS/STD Control and Prevention
Beijing, China
Dr. Zhao Yan没有相关的利益冲突要报告。
UNAIDS数据显示, 2020年,50岁以上HIV感染者达到690万[1]。存活感染者高年龄组构成趋增,荷兰等欧洲国家预计到2030年≥50年龄组的HIV感染者将达到70% [2]。老年HIV感染者数量增加有两个主要原因:①该年龄组新发感染者增加;②有效的抗反转录病毒治疗(antiretroviral therapy, ART)延长了患者寿命。老年人受到免疫功能改变和慢性炎症的长期影响,有更高的风险罹患多种年龄相关的合并症,如神经认知障碍、肾病、肝病、骨质疏松症、心血管疾病和虚弱[3, 4]。HIV病毒感染导致老龄化进程加剧,2019年有研究发现,与HIV感染有关的因素如巨细胞病毒感染或乙肝合并感染、CD8+ T细胞激活和免疫缺陷(CD4+ T细胞计数<200细胞/μ)等均会加速衰老[5]。
2020年格拉斯哥举办艾滋病大会报告显示[6],高收入国家HIV感染者出现明显老龄化,相反中低收入国家的相关研究较少。老龄化引起的代谢综合症,叠加HIV感染引发的代谢异常、抗HIV病毒药物等一系列影响,使得老年化患者的医疗负担明显加剧[7, 8]。相比来说,老年女性较老年男性拥有更好的免疫功能恢复和更少的心血管疾病,但是女性在体能恢复以及生活质量方面低于男性[9]。
2019年第十届艾滋病与老龄化国际研讨会也提出[10],老年感染者面临着免疫衰老影响、合并症增加、多药治疗和虚弱等复杂问题。暴露于多种药物,容易与ART发生药物相互作用,并对依从性产生负面影响。尽管启动ART后实现了病毒抑制,但许多老年感染者会更早出现心血管疾病、非艾滋病定义的恶性肿瘤和神经认知功能障碍等[11]合并症。
截止2019年,中国在治HIV 感染者86.3万,其中45-64岁者占37%,65岁以上者占11%。2019新诊断的感染者中,60岁以上年龄者仍占25%。因此,未来整个项目将面临重大的疾病负担,同时也会影响成功率、死亡等重要的产出指标。目前尚没有太多高质量的证据指导老年感染者的抗病毒治疗,特别是叠加多种合并症者。即使美国卫生与公众服务部,也强调艾滋病毒专家、初级保健提供者和多学科专家应共同努力,优化老年HIV感染者的医疗护理指导,以满足日益增长的艾滋病毒老龄化人群的特殊且迫切的需求[12]。
参考文献
[1] UNAIDS. Get on the fast-track, the life-cycle approach to HIV 2016[EB/OL]. [2020/10/20]. Available at: http://www.unaids.org/sites/default/files/media_asset/Get-on-the-Fast-Track_en.pdf.
[2] Masters M. C., Erlandson K. M. Editorial: Forging new frontiers in HIV and aging[J]. Curr Opin HIV AIDS, 2020,15(2):81-82.
[3] Aung H. L., Aghvinian M., Gouse H., et al. Is There Any Evidence of Premature, Accentuated and Accelerated Aging Effects on Neurocognition in People Living with HIV? A Systematic Review[J]. AIDS Behav, 2020.
[4] Mahale P., Engels E. A., Coghill A. E., et al. Cancer Risk in Older Persons Living With Human Immunodeficiency Virus Infection in the United States[J]. Clin Infect Dis, 2018,67(1):50-57.
[5] De Francesco D., Wit F. W., Burkle A., et al. Do people living with HIV experience greater age advancement than their HIV-negative counterparts?[J]. AIDS, 2019,33(2):259-268.
[6] HIV Glasgow - Virtual, 5-8 October 2020[J]. J Int AIDS Soc, 2020,23 Suppl 7:e25616.
[7] Martin-Iguacel R., Negredo E., Peck R., et al. Hypertension Is a Key Feature of the Metabolic Syndrome in Subjects Aging with HIV[J]. Curr Hypertens Rep, 2016,18(6):46.
[8] Negredo E., Warriner A. H. Pharmacologic approaches to the prevention and management of low bone mineral density in HIV-infected patients[J]. Curr Opin HIV AIDS, 2016,11(3):351-357.
[9] Fatima B., Matilde S. C., Federica C., et al. Sex Difference In People Aging With Hiv[J]. J Acquir Immune Defic Syndr, 2020.
[10] Shiau S., Bender A. A., O'Halloran J. A., et al. The Current State of HIV and Aging: Findings Presented at the 10th International Workshop on HIV and Aging[J]. AIDS Res Hum Retroviruses, 2020.
[11] Maciel R. A., Kluck H. M., Durand M., et al. Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: A cross-sectional study[J]. Int J Infect Dis, 2018,70:30-35.
[12] DHHS. Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV[EB/OL].[2020/10/20].https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines.
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