透過簡單的評分系統準確繪製老年愛滋病毒感染者的生存前景

基思·奧爾康 / 2022 年 11 月 1 日 /aidsmap / 財團法人台灣紅絲帶基金會編譯

 

圖片：Maxime Hentzien 博士在 HIV Glasgow 2022 上發表演講。圖片來自 Alan Donaldson Photography。

 

根據上週在格拉斯哥舉行的愛滋病毒藥物治療大會上提交的一項瑞士研究結果，一種可以確定哪些愛滋病毒感染者預後較差的評分系統在瑞士愛滋病毒感染者中與在法國人口中一樣準確.

確定哪些 HIV 感染者生存不良的風險較高，對於確定臨床介入的優先次序以及突顯可能對提高 HIV 感染者的預期壽命產生更大影響的預防措施非常重要。評分系統還可以為分數較低的人提供保證。

Maxime Hentzien 博士和法國同事通過觀察 2008 年至 2013 年 1,583 名 60 歲及以上愛滋病毒感染者的健康結果開發了 Dat’AIDS 評分系統。

該研究尋找與死亡風險增加相關的風險因素，並根據任何特定因素增加死亡風險的程度開發了一個評分系統。

該研究確定了與死亡風險相關的八個因素：

• 年齡（65 歲以上 1 分，75 歲以上 8 分）

• CD4 計數（如果低於 350 則為 3 分，如果低於 200 則為 6 分）

• 非 HIV 相關癌症（6 分）

• 心血管疾病（8 分）

• 腎功能（如果估計腎小球濾過率低於 60，則為 5 分，如果低於 30，則為 16 分）

• 肝硬化（13 分）

• 低體重指數（如果低於 18.5，則為 10 分）

• 貧血（6 分）。

在 60 歲以上的愛滋病毒感染者中，低分 (0-3) 與 95% 的生存概率相關。低分僅適用於 75 歲以下且 CD4 計數高於 200 的人，腎功能在正常範圍內，無其他危險因素。

中度風險評分（4-13）與 5 年追蹤後 90% 的生存概率相關。中等風險評分意味著存在幾個風險因素，年齡超過 75 歲或 CD4 計數低於 200。

高風險評分 (14-20) 與 77% 的生存概率相關，極高風險評分 (>20) 與 54% 的生存概率相關。處於任一風險類別都意味著在 CD4 計數低於 200 或超過 75 歲的人中至少存在一種主要合併症，或多種合併症。

該分數是在一個法國世代中開發的，但尚不清楚該結果是否可以在另一個歐洲人群中重現。為了測試評分系統，Hentzien 與瑞士 HIV Cohort 合作評估評分系統在 2015 年至 2020 年間所有 60 歲或以上的世代成員中的預測可靠性。他們確定了 2,205 名符合納入分析條件的人。

符合納入條件的參與者主要是男性 (81%)，平均分為男同性戀和雙性戀男性 (46%) 和異性戀者 (40%)。幾乎所有人都在接受抗反轉錄病毒治療（96%），92% 的病毒載量低於 50，CD4 計數中位數很高（586）。 4% 的 CD4 計數低於 200。

不到 6% 的人年齡在 75 歲或以上，27% 的人年齡在 65 至 75 歲之間。 14% 的人患有心血管疾病，18% 的人腎功能下降，不到 11% 的人患有貧血症。肝硬化 (2%)、非 HIV 癌症 (3%) 和低體重指數 (4%) 並不常見。

在 7,147 人年的追蹤中，共有 154 人死亡。參與者的中位得分為 3 分，評分系統預測的結果與觀察到的死亡率非常一致。

在 1,191 名低風險參與者中，中位得分為 0，5 年預測生存率 (95%) 與觀察到的生存概率 (96%) 相匹配。

在 776 名中度風險參與者中，中位得分為 8 分，5 年預測生存率為 90%，觀察到的生存概率為 89%。

在 154 名高危參與者中，中位得分為 16，5 年預測生存率為 77%，觀察到的生存概率為 75%。

在 84 名非常高風險的參與者中，中位得分為 23，5 年預測生存率為 55%，觀察到的生存概率為 65%。

研究人員表示，他們的結果不能在歐洲範圍之外應用。他們仍在與另一個預測量表 VACS 評分系統進行比較，以檢查他們的評分系統是否足夠準確。他們還想研究 60 歲以下 HIV 感染者的量表的有效性，並評估該量表是否可用於預測生活質量或衰弱等負面老年結果。

 

參考文獻：

Hentzien M 等人。愛滋病毒感染者死亡風險指數的推導和內部驗證：Dat’AIDS 評分。 PLoS One 13(4): e0195725, 2018（開放獲取）。https://doi.org/10.1371/journal.pone.0195725

Hentzien M 等人。在瑞士 HIV 世代研究中對 Dat’AIDS 評分預測老年 HIV 感染者 5 年死亡率的外部驗證。 HIV 藥物治療大會，格拉斯哥，摘要 O32，2022。

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Survival prospects for older people with HIV plotted accurately by simple scoring system

Keith Alcorn / 1 November 2022 / aidsmap

 

Dr Maxime Hentzien presenting at HIV Glasgow 2022. Image by Alan Donaldson Photography.

A scoring system that can identify which older people with HIV have a poorer prognosis is just as accurate in Swiss people with HIV as in the French population, according to results of a Swiss study presented at the Congress on Drug Therapy in HIV last week in Glasgow.

Identifying which people with HIV have a higher risk of poor survival is important for prioritising clinical interventions, as well as for highlighting preventive measures that are likely to have a greater impact on improving life expectancy in older people with HIV. The scoring system can also provide reassurance to those with lower scores.

Dr Maxime Hentzien and French colleagues developed the Dat’AIDS scoring system by looking at the health outcomes of 1583 people with HIV aged 60 and over, followed from 2008 to 2013.

The study looked for risk factors associated with an increased risk of death and developed a scoring system based on the extent to which any specific factor increased the risk of death.

The study identified eight factors associated with the risk of death:

•Age (1 point if over 65, 8 points if over 75)

•CD4 count (3 points if below 350, 6 points if below 200)

•Non-HIV-related cancer (6 points)

•Cardiovascular disease (8 points)

•Kidney function (5 points if estimated glomerular filtration rate is below 60, 16 points if below 30)

•Cirrhosis of the liver (13 points)

•Low body mass index (10 points if below 18.5)

•Anaemia (6 points).

A low score (0-3) was associated with a 95% probability of survival after five years of follow-up in people with HIV over 60. A low score was only possible for people under the age of 75, with CD4 counts above 200, kidney function in the normal range and no other risk factors.

A moderate-risk score (4-13) was associated with a 90% probability of survival after 5 years of follow-up. A moderate-risk score implied the presence of several risk factors, age over 75 or a CD4 count below 200.

A high-risk score (14-20) was associated with a 77% probability of survival and a very high-risk score (>20) was associated with a 54% probability of survival. Being in either risk category implied the presence of at least one major comorbidity in a person who had a CD4 count below 200 or was over 75 years old, or multiple co-morbidities.

The score was developed in a French cohort, but it was unclear if the results could be reproduced in another European population. To test the scoring system, Hentzien worked with the Swiss HIV Cohort to evaluate the predictive reliability of the scoring system in all cohort members aged 60 or over between 2015 and 2020. They identified 2205 people eligible for inclusion in the analysis.

The participants eligible for inclusion were predominantly male (81%) and evenly divided between gay and bisexual men (46%) and heterosexuals (40%). Almost all were taking antiretroviral treatment (96%), 92% had a viral load below 50 and the median CD4 count was high (586). Four per cent had a CD4 count below 200.

Just under 6% were aged 75 or over and 27% were aged 65 to 75 years. Fourteen per cent had cardiovascular disease, 18% had reduced kidney function and just under 11% had anaemia. Cirrhosis (2%), non-HIV cancers (3%) and low body mass index (4%) were uncommon.

A total of 154 deaths occurred during 7,147 person-years of follow-up. The median score among participants was 3 and the outcomes predicted by the scoring system showed very good concordance with observed mortality.

Among the 1,191 low-risk participants, the median score was 0 and 5-year predicted survival (95%) matched the observed probability of survival (96%).

Among the 776 moderate-risk participants, the median score was 8, the 5-year predicted survival was 90% and the observed probability of survival was 89%.

Among the 154 high-risk participants, the median score was 16, the 5-year predicted survival was 77% and the observed probability of survival was 75%.

Among the 84 very high-risk participants, the median score was 23, the 5-year predicted survival was 55% and the observed probability of survival was 65%.

The study investigators say that their results cannot be applied outside a European context. They are still working on comparisons with another predictive scale, the VACS scoring system, to check whether their scoring system is sufficiently accurate. They also want to look at the validity of scale in people with HIV under 60 years old, and to assess whether the scale can be used to predict quality of life or negative geriatric outcomes such as frailty.

References

Hentzien M et al. Derivation and internal validation of a mortality risk index for aged people living with HIV: The Dat’AIDS score. PLoS One 13(4): e0195725, 2018 (open access).

https://doi.org/10.1371/journal.pone.0195725

Hentzien M et al. External validation of the Dat’AIDS score for predicting 5-year mortality among elderly patients living with HIV in the Swiss HIV Cohort Study. Congress on HIV Drug Therapy, Glasgow, abstract O32, 2022.