The importance of comorbidity in HIV-infected patients over 55: A retrospective case-control study

被引:106
作者
Skiest, DJ
Rubinstien, E
Carley, N
Gioiella, L
Lyons, R
机构
[1] ST FRANCIS HOSP & MED CTR, HARTFORD, CT USA
[2] MT SINAI HOSP, HARTFORD, CT USA
[3] UNIV CONNECTICUT, CTR HLTH, FARMINGTON, CT USA
关键词
D O I
10.1016/S0002-9343(96)00329-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
PURPOSE: TO study the impact of comorbidity on the course of HIV disease in older patients as compared to a matched cohort of younger patients. METHODS: In a retrospective case-control study, we compared 43 HIV-infected patients >55 years old to a randomly selected cohort of 86 patients <45 years old, matched by date of HIV diagnosis. We collected data on non-HIV-related morbidity (as assessed by the Charlson comorbidity index), initiator of HIV testing, HIV stage at time of HIV diagnosis (TOHD), AIDS defining diagnoses, AIDS-related illnesses (ARI), observed AIDS-free interval, survival, and frequency of HIV-related and unrelated hospitalizations. RESULTS: The older cohort was more likely to have had HIV testing initiated by a health care provider (36 of 36 versus 50 of 66, P = 0.003), and to have acquired HIV from a transfusion (5 of 43 versus 0 of 86, P = 0.001), had lower CD4 cell counts at TOHD (205 versus 429, P = 0.02), a shorter observed AIDS-free interval (24.0 versus 52.8 months, P = 0.0002) and a shorter survival (28.2 versus 58.9 months, P = 0.0002). The older cohort had more HN-related (13.4 versus 9.2 per 100 patient-months, P = 0.024) and non-HIV-related hospitalizations (12.9 versus 8.1 per 100 patient-months, P = 0.0001). The comorbidity index was significantly higher in the older cohort (0.907 versus 0.198, P = 0.0001) and was a strong predictor of mortality, independent of age group (risk ratio = 1.38 per comorbidity point, P = 0.0003). CONCLUSIONS: Older HIV-infected patients presented with more advanced disease, which may have been due to lack of HIV awareness in this population. Older patients had a shorter observed AIDS-free interval and shorter survival. In addition, they had more HIV- and non-HIV-related comorbidity. The more rapid course and decreased survival in the elderly may be related to the increase in comorbidity. (C) 1996 by Excerpta Medica, Inc.
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页码:605 / 611
页数:7
相关论文
共 32 条
[1]   SURVIVAL PATTERNS OF THE 1ST 500 PATIENTS WITH AIDS IN SAN-FRANCISCO [J].
BACCHETTI, P ;
OSMOND, D ;
CHAISSON, RE ;
DRITZ, S ;
RUTHERFORD, GW ;
SWIG, L ;
MOSS, AR .
JOURNAL OF INFECTIOUS DISEASES, 1988, 157 (05) :1044-1047
[2]   THE INFLUENCE OF AGE ON THE LATENCY PERIOD TO AIDS IN PEOPLE INFECTED BY HIV THROUGH BLOOD-TRANSFUSION [J].
BLAXHULT, A ;
GRANATH, F ;
LIDMAN, K ;
GIESECKE, J .
AIDS, 1990, 4 (02) :125-129
[3]   EFFECT OF AGE AND EXPOSURE GROUP ON THE ONSET OF AIDS IN HETEROSEXUAL AND HOMOSEXUAL HIV-INFECTED PATIENTS [J].
CARRE, N ;
DEVEAU, C ;
BELANGER, F ;
BOUFASSA, F ;
PERSOZ, A ;
JADAND, C ;
ROUZIOUX, C ;
DELFRAISSY, JF ;
BUCQUET, D ;
DELLAMONICA, P ;
GALLAIS, H ;
DORMONT, J ;
LEFRERE, JJ ;
CASSUTO, JP ;
DUPONT, B ;
VITTECOQ, D ;
HERSON, S ;
GASTAUT, JA ;
SERENI, D ;
VILDE, JL ;
BRUCKER, G ;
KATLAMA, C ;
SOBEL, A ;
DUVAL, J ;
KAZATCHINE, M ;
LEBRAS, P ;
EVEN, P ;
GUILLEVIN, L .
AIDS, 1994, 8 (06) :797-802
[4]  
CDC, 1987, MMWR-MORBID MORTAL W, V36, p1S
[5]  
*CDCP, 1995, HIV AIDS SURVEILLANC, V7, P1
[6]  
*CDCP, 1993, HIV AIDS SURVEILLANC, V5, P1
[7]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[8]   UNRECOGNIZED HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION IN THE ELDERLY [J].
ELSADR, W ;
GETTLER, J .
ARCHIVES OF INTERNAL MEDICINE, 1995, 155 (02) :184-186
[9]   NATURAL-HISTORY OF HUMAN IMMUNODEFICIENCY VIRUS-INFECTIONS IN HEMOPHILIACS - EFFECTS OF T-CELL SUBSETS, PLATELET COUNTS, AND AGE [J].
EYSTER, ME ;
GAIL, MH ;
BALLARD, JO ;
ALMONDHIRY, H ;
GOEDERT, JJ .
ANNALS OF INTERNAL MEDICINE, 1987, 107 (01) :1-6
[10]   SEX, AIDS, AND THE ELDERLY [J].
FELDMAN, MD .
ARCHIVES OF INTERNAL MEDICINE, 1994, 154 (01) :19-20