HIV Patients Older Than 50 Live with Multimorbidities, Higher Disease Burden Than HIV-Negative Persons

Eduardo Sprinz, MD, infectiologist, Hospital de Clinicas de Porto Alegre

Eduardo Sprinz, MD

In patients aged 50 years and older who are living with HIV, the presence of multiple morbidities accompanying their condition is more common compared with the uninfected population.

The most common comorbidities that increase disease burden in this population include hypertension, diabetes, chronic kidney disease, bone disease, hepatic disease, cardiovascular disease and neoplastic disease.¹

According to a study published in the International Journal of Infectious Disease, the HIV-positive patients had an approximately 3-times higher prevalence of morbidities than HIV-negative participants, with the majority of disease burden observed in these HIV-positive patients fueled primarily by bone, hepatic and renal disease.

“The data from this study confirm that a longer duration of HIV infection and multiple antiretroviral regimens are risk factors for multimorbidity [and] independent of age," Eduardo Sprinz, MD, leading study investigator, infectiologist, Hospital de Clínicas de Porto Alegre, adds.

In this cross-sectional analysis of an HIV cohort in South Brazil, investigators compared the prevalence of multimorbidities among HIV-positive patients >50 years old (n= 208) versus HIV-negative age-matched controls (n= 208). Multimorbidity was defined as the presence of ≥2 comorbid conditions, including hypertension, diabetes, chronic kidney disease, bone disease, hepatic disease, cardiovascular disease, and neoplastic disease. Additionally, the investigators collected data on current viral load (copies/ml), CD4 cell count (cells/μl), CD4/CD8 ratio, lowest CD4 count since being diagnosed with HIV (CD4 nadir, cells/μl), and the duration and type of antiretroviral therapy taken by HIV-positive participants.

The majority of HIV patients in this cohort were taking highly active antiretroviral therapy (98.1%) and presented with an undetectable viral load (88%). Approximately half of patients had a CD4/CD8 ratio <0.7, and the median current CD4 count at baseline was 598 cells/μl (interquartile range 400—790 cells/μl).

A significantly greater proportion of patients with HIV were living with multimorbidity compared with controls (63% [95% CI 57—70%] vs 43% [95% CI 37–52%], respectively; P <.001). Overall, the median number of comorbid conditions for the HIV and control groups were 2 and 1, respectively (P <.001). The only 2 variables associated with a higher multimorbidity prevalence included having an HIV-positive diagnosis (prevalence ratio 1.47, P <.001) and age (15% per 5 years >50 years old, P <.001). In addition, the adjusted analysis found that the most significant variables associated with greater multimorbidity prevalence included age (P =.015), HIV infection duration (P =.027), and the time on antiretroviral therapy (P =.015).

Alcohol use was significantly higher among HIV-positive vs. HIV-negative participants (16% vs 6%, respectively; P =.003), which may have been a factor driving some (but not all) morbidities in this patient population. Also, due to the study’s cross-sectional design, the findings are limited to inferring associations between HIV patient characteristics and multimorbidity prevalence, rather than elucidating causative components.

“This study adds new data for aging in the HIV population in the developing world and also suggests that long-term cART exposure and HIV duration have deleterious effects,” concluded the investigators. “It is considered that these results could be generalized to aging HIV cohorts with good virological outcomes and long-term exposure to antiretroviral drugs.”

REFERENCE

1. Maciel RA, Klück HM, Durand M, Sprinz E. Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: A cross-sectional study. Int J Infect Dis. 2018;70:30-35.