尽管与HIV感染者（PWH）的生活质量和死亡率相关的年龄相关并发症对于老年人来说越来越成为一个威胁，但缺乏针对并发症筛查和预防的临床指导。了解性别对并发症分布和严重性的影响对于制定促进HIV感染成年人健康老龄化的指南至关重要。为了评估HIV对美国成年人老年相关并发症负担的影响，这项横断面分析包括来自美国多中心观察性队列研究的数据，其中包括了HIV感染的男性（多中心艾滋病队列研究）和女性（妇女间联合HIV研究）以及人口学上相似的HIV阴性个体。参与者从2008年（男性）和2009年（女性）开始进行前瞻性随访（当时80％以上的HIV感染参与者报道使用抗逆转录病毒疗法），直到最后观察日截至2019年3月，然后评估结果。数据分析时间为2020年7月至2021年4月。研究变量包括HIV感染、年龄和性别。按参与者每人的总并发症数量（根据评估的10项标准）评估并发症负担；次要结果包括各种不同并发症的患病率。线性回归评估了HIV感染状况、年龄和性别与并发症负担之间的关联。总共包括5929名个体（年龄中位数[四分位数]，54 [46-61]岁；3238名女性[55%]；2787名黑人[47%]，1153名西班牙裔或其他人种[19%]，1989名白人[34%]）。总体而言，未经调整的平均并发症负担在女性中高于男性（3.4 [2.1] vs 3.2 [1.8]，P = .02）。不同的患病率在性别间存在差异，包括高血压（3238名女性中有2188例[68%] vs 2691名男性中的2026例[75%]）、精神疾病（1771名女性[55%] vs 1565名男性[58%]）、血脂异常（1312名女性[41%] vs 1728名男性[64%]）、肝病（1093名女性[34%] vs 1032名男性[38%]）、骨病（1364名女性[42%] vs 512名男性[19%]）、肺病（1245名女性[38%] vs 259名男性[10%]）、糖尿病（763名女性[24%] vs 470名男性[17%]）、心血管疾病（493名女性[15%] vs 407名男性[15%]）、肾病（444名女性[14%] vs 404名男性[15%]）和癌症（219名女性[7%] vs 321名男性[12%]）。在未经调整的模型中，与男性相比，HIV感染者的女性在每个年龄段的并发症负担平均差异均显著增大：40岁以下年龄组，0.33（95％ CI，0.03-0.63）；40至49岁年龄组，0.37（95％ CI，0.12-0.61）；50至59岁年龄组，0.38（95％ CI，0.20-0.56）；60至69岁年龄组，0.66（95％ CI，0.42-0.90）；70岁及以上年龄组，0.62（95％ CI，0.07-1.17）。然而，在没有HIV的人群中，性别差异在不同年龄组中有所变化：40岁以下年龄组，0.52（95％ CI，0.13 to 0.92）；40至49岁年龄组，-0.07（95％ CI，-0.45 to 0.31）；50至59岁年龄组，0.88（95％ CI，0.62 to 1.14）；60至69岁年龄组，1.39（95％ CI，1.06 to 1.72）；70岁及以上年龄组，0.33（95％ CI，-0.53 to 1.19）（P交互作用= .001）。在协变量调整模型中，结果略有减弱，但仍具有统计学意义。在这个横断面研究中，与男性相比，女性的老年相关并发症负担总体更重，尤其是在HIV感染者中，并且不同性别之间并发症患病率的分布也有所不同。可能需要根据HIV感染状况、性别或社会性别量身定制的并发症筛查和预防策略。

Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV.To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era.This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021.HIV, age, sex.Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden.A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P = .02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, -0.07 (95% CI, -0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, -0.53 to 1.19) (P for interaction = .001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance.In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.