The higher prevalence of comorbidities associated with ageing in patients with vs without HIV infection increases at a similar rate over time and is associated with increased mortality risk, including due to non-AIDS-related malignancies. These study results were published in The Lancet HIV.
Researchers conducted a prospective, longitudinal cohort study to evaluate the prevalence of comorbidities associated with ageing among HIV-positive (n=596) and HIV-negative patients (n=550) aged 45 years and older. All HIV-positive patients were receiving effective antiretroviral therapy. The mean number of comorbidities for each group was compared over time using Poisson regression. Mean disability-adjusted life-years (DALYs) were also compared between the groups via exponential hurdle modeling and used to measure disease burden.
Among patients with (n=596) and without (n=550) HIV infection included in the final analysis, the median age was 52 (IQR, 48-59) and 52 (IQR, 48-58) years, 87.6% and 84.6% were men, 87.6% and 95.6% were White, and 4.2% and 1.3% had 3 or more comorbidities associated with ageing, respectively. Of the men, 78.0% and 79.4% were men who have sex with men (MSM).
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At baseline, the mean number of comorbidities was significantly higher among patients in the HIV-positive vs HIV negative groups (0.65 vs 0.32; P <.0001). In addition, similar increases in the mean number of comorbidities over time were observed among HIV-positive (rate ratio [RR], 1.04 per year; 95% CI, 1.00-1.08) and HIV-negative patients (RR, 1.05 per year; 95% CI, 1.01-1.08; Pinteraction =.78).
Of HIV-positive and HIV-negative patients, mortality due to ageing-associated comorbidities occurred among 24 and 2 patients and mortality due to non-AIDS-related malignancies occurred among 15 and 1 patient(s), respectively.
For every additional comorbidity, there was an associated increased risk of death (hazard ratio, 3.33; 95% CI, 2.27-4.88, P <.001). The most common comorbidities reported were kidney disease (16.8%), osteoporosis (9.6%), and chronic obstructive pulmonary disease (9.3%). Of note, kidney disease and osteoporosis were more prevalent in HIV-positive patients.
During the 24 months prior to enrollment, there were zero DALYs among 368 (61.7%) and 436 (79.3%) HIV-positive and HIV-negative patients, respectively. There also were significantly higher increases in mean DALYs observed among HIV-positive (0.209 per year; 95% CI, 0.162-0.256) vs HIV-negative patients (0.091 per year; 95% CI, 0.025-0.157) throughout the follow-up period (Pinteraction =.005). The change in mean DALYs did not significantly differ between the groups after the exclusion of years of life lost from the DALY estimate.
Study limitations include potential differential screening bias, a higher number of self-reported comorbidities among patients with vs without HIV infection, and the predominance of White MSM.
According to the researchers, “Our findings highlight the need for strategies to optimize prevention, screening, and early intervention for ageing-associated comorbidities and non-AIDS malignancies, particularly for long-term survivors with HIV as they age.”
Reference
Verheij E, Boyd A, Wit FW et al; on behalf of the AGEhIV cohort study. Long-term evolution of comorbidities and their disease burden in individuals with and without HIV as they age: analysis of the prospective AGEhIV cohort study. Lancet HIV. Published online February 9, 2023. doi:10.1016/S2352-3018(22)00400-3
This article originally appeared on Infectious Disease Advisor
