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Earlier Age of Onset and Higher Prevalence of Comorbidities in People Living with HIV:
A Population-Based Cohort Study in British Columbia, Canada
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"PLWH experienced all comorbidities at a significantly younger age than their counterparts, ranging between 5 years earlier for hypertension and 28 years for kidney diseases. See figure for an example of trends of prevalence and age of onset of two key comorbidities in these populations......Our results showed that PLWH experience earlier onset of non-HIV related comorbidities that can contribute to accelerated aging......These results further stress the need for early HIV diagnosis and ART initiation with maintenance of long-term virologic suppression, as well as optimized general clinical screening for comorbidities at earlier age among PLWH.” from Jules: look at Figure 2A to see the stark earlier onset for specific comorbidities in HIV+ vs HIV-neg of CVD, liver disease, osteoarthritis, kidney diseases, lung diseases, diabetes, cancers, mental disorders, personality disorders, mood and anxiety disorders, ad schizophrenia. This is the very first report I have seen so clearly examining & reporting the ages at which earlier onset of comorbidities occurs in HIV+ vs HIV-.
Reported by Jules Levin
CROI 2019 March 4-7 Seattle
Ni Gusti Ayu Nanditha, Martin St-Jean, Hiwot Tafessu, Michelle Lu, Kate Salters, Silvia
Guillemi, Julio Montaner, Robert S. Hogg, Viviane D. Lima
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
Program Abstract
As people living with HIV (PLWH) are living longer, premature morbidity and mortality from age-associated comorbidities are more common. Our objective was to compare prevalence trends and age of onset of comorbidities between PLWH and the general population in British Columbia (BC).
This retrospective cohort study used longitudinal data from the Comparative Outcomes and Service Utilization Trends study, a population-based cohort of PLWH and 10% random representative sample of BC population. Eligible participants were ≥19 years old and followed for 1 year between 2000 and 2012. PLWH were antiretroviral therapy (ART) naïve. Age-related comorbidities were identified from hospital and physician billing provincial databases using the International Classification of Disease versions 9/10. Selected comorbidities included cardiovascular, kidney, lung, and liver diseases, non-AIDS-defining cancers, diabetes, osteoarthritis and hypertension. Generalized non-linear models (assuming a beta distribution and a logit link) modeled the prevalence trends, and the Mann-Whitney U test compared the distribution of age of onset of comorbidities between both populations.
The study included 4,223 PLWH and 454,092 HIV-negative individuals (median age 37 vs. 39 years, 80% vs. 50% men, median follow-up 5 vs. 13 years, respectively). Yearly prevalence of diabetes, kidney, liver, and lung diseases were significantly higher among PLWH, while the remaining comorbidities were significantly higher among HIV-negative individuals. The gap in prevalence of kidney and liver diseases between the two populations is considerably wide, while for cardiovascular diseases and diabetes, it is rapidly narrowing. PLWH experienced all comorbidities at a significantly younger age than their counterparts, ranging between 8 years earlier for hypertension and 22 years for kidney diseases. See figure for an example of trends of prevalence and age of onset of two key comorbidities in these populations.
Our results showed that PLWH experience earlier onset of non-HIV related comorbidities that can contribute to accelerated aging. The gaps in the prevalence of comorbidities could be related to HIV related inflammation, life-style issues and toxicities related to older ART. These results further stress the need for early HIV diagnosis and ART initiation with maintenance of long-term virologic suppression, as well as optimized general clinical screening for comorbidities at earlier age among PLWH.
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