老年人艾滋病毒/艾滋病负担的长期演变：七国集团国家75岁以上个人的全球疾病负担分析

摘要(中文译文)

随着抗逆转录病毒治疗（ART）的广泛实施，人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）已逐渐从高致死性传染病转变为可管理的慢性疾病。与此同时，全球人口老龄化进程加快，使≥75岁老年HIV感染者成为疾病负担日益重要的群体。然而，该人群的流行病学特征、疾病谱及长期趋势——包括发病率、死亡率、患病率和伤残调整生命年（DALYs）等关键指标——仍缺乏充分评估，尤其是G7国家该年龄组的流行病学转变及国家间差异方面。研究从全球疾病负担（GBD）2021数据库中获取1990至2021年G7国家（加拿大、法国、德国、意大利、日本、英国和美国）≥75岁人群HIV/AIDS及其亚型数据。指标包括年龄标化发病率（ASIR）、年龄标化死亡率（ASMR）、年龄标化患病率（ASPR）和DALYs。按年龄组（75-79、80-84、85-89、90-94、≥95岁）、性别和疾病亚型进行分层分析。采用Joinpoint回归评估长期趋势，计算年度百分比变化（APC）和平均年度百分比变化（AAPC）。1990至2021年间，大多数G7国家老年人群HIV/AIDS的发病率和死亡率持续下降，反映了ART和公共卫生干预的有效性。相反，部分国家的患病率和DALYs上升，呈现“发病率与死亡率下降，但生存期延长与伤残增加”的非对称模式。国家间存在显著异质性：美国和若干欧洲国家存活人群疾病负担较高，而日本呈持续上升趋势。性别特异性分析显示男性总体负担高于女性，但在最高年龄组中性别差距缩小。疾病谱随时间变化，药物敏感性结核负担下降，非传染性慢性疾病（与HIV/AIDS相关的病症）成为DALYs的主要驱动因素。应将老年人纳入HIV预防、筛查和健康管理策略，尤其关注慢性病管理、功能维持和多学科照护，以应对老龄化HIV队列带来的长期健康挑战。

Abstract

With the widespread implementation of antiretroviral therapy (ART), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has gradually transitioned from a highly fatal infectious disease to a manageable chronic condition. Simultaneously, global population aging has accelerated, making older adults with HIV (≥75 years) an increasingly important group in terms of disease burden. However, the epidemiological characteristics, disease spectrum, and long-term trends of this population-including key metrics such as incidence, mortality, prevalence, and disability-adjusted life years (DALYs)-remain inadequately assessed, particularly regarding epidemiological transitions and inter-country differences in this age group across G7 nations. Data on HIV/AIDS and its subtypes from 1990 to 2021 were obtained from the Global Burden of Disease (GBD) 2021 database for G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) among individuals aged ≥75 years. Metrics included age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and DALYs. Stratified analyses were performed by age groups (75-79, 80-84, 85-89, 90-94, ≥95 years), sex, and disease subtype. Long-term trends were assessed using Joinpoint regression, calculating the annual percent change (APC) and average annual percent change (AAPC). Between 1990 and 2021, the incidence and mortality of HIV/AIDS in older adults declined continuously in most G7 countries, reflecting the effectiveness of ART and public health interventions. In contrast, prevalence and DALYs increased in some countries, indicating an asymmetric pattern of "decreasing incidence and mortality, but increasing survival and disability." Considerable heterogeneity existed among countries: the United States and several European countries exhibited a high burden among surviving individuals, whereas Japan showed a consistently increasing trend. Sex-specific analysis revealed a higher overall burden in males than females, although the sex gap narrowed in the oldest age groups. The disease spectrum shifted over time, with a declining burden of drug-susceptible tuberculosis and non-communicable chronic diseases (conditions associated with HIV/AIDS) emerging as the primary drivers of DALYs. Older adults should be incorporated into HIV prevention, screening, and health management strategies, with particular attention to chronic disease management, functional maintenance, and multidisciplinary care to address the long-term health challenges posed by aging HIV cohorts.

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