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Higher MI, ESRD, Cancer Rates With HIV--But Not Necessarily at Younger Age
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20th Conference on Retroviruses and Opportunistic Infections, March 3-6, 2013, Atlanta
Mark Mascolini
HIV-positive people in the Veterans Aging Cohort Study (VACS) Virtual Cohort had substantially higher rates of myocardial infarction (MI), certain non-AIDS cancers, and end-stage renal disease (ESRD) than did HIV-negative veterans [1]. MIs and ESRD did not arise at an earlier age in the HIV group after the investigators accounted for other risk factors, but non-AIDS cancers did.
Research documents higher rates of cardiovascular disease, certain non-AIDS cancers, and kidney disease in people with HIV than in the general population. And some work indicates that these morbidities may arise at a younger age in HIV-positive people. But the VACS collaborators noted that one group may be at greater risk of a disease than a comparison group, but not necessarily at a younger age. To see how HIV, age, and risk of MI, cancer, and ESRD intersect in the VACS cohort, the VACS team conducted this study.
After excluding people who already had an MI, a non-AIDS cancer, or ESRD, the researchers counted new diagnoses of each disease in HIV-positive veterans, each matched to 2 HIV-negative veterans by age, gender, race/ethnicity, and clinical site. The investigators used linear regression models to estimate differences in mean age at disease diagnosis, and they used Poisson regression models to estimate incidence rates and adjusted incidence rate ratios (aIRR) for each condition. All statistical models were adjusted for age, race, sex, hepatitis C infection, body mass index, alcohol use, cigarette smoking, anemia, and diabetes. The MI and ESRD models were also adjusted for hyperlipidemia, lipid-lowering drug use, hypertension, and antihypertensive use.
The MI analysis included 27,988 veterans with HIV and 56,456 without HIV. The adjusted difference in average age at MI, -0.04 year, was not statistically significant (95% confidence interval [CI] -0.62 to 0.54). During follow-up, 231 people with HIV and 286 without HIV had an MI to yield respective incidence rates of 2.18 and 1.31 per 1000 person-years. The adjusted incidence rate ratio indicated that people with HIV had almost a doubled MI rate (aIRR 1.81, 95% CI 1.49 to 2.20).
Other factors that independently raised MI risk were age, race, smoking, anemia, diabetes, hyperlipidemia, hypertension, and antilipid and antihypertensive drug use.
The ESRD analysis involved 31,139 people with HIV and 68,113 without HIV, with respective average ages of 55.3 and 58.5 years at ESRD diagnosis. The adjusted difference in average age at diagnosis was not statistically significant (-0.23 year, 95% CI -0.69 to 0.23). While 346 cases of ESRD arose in the HIV group, 502 developed in the control group, yielding incidence rates of 2.93 per 1000 person-years with HIV and 1.88 without HIV. Veterans with HIV had a 43% higher rate of ESRD (aIRR 1.43, 95% CI 1.22 to 1.65).
Other factors that raised the risk of ESRD were age, race, body mass index, hepatitis C infection, smoking, alcohol use, anemia, hypertension, antihypertensive use, and antilipid drug use.
The researchers divided non-AIDS cancers into "HIV-associated cancers" and "other cancers." The HIV-associated cancers (which some studies describe as more frequent in people with HIV) were anal cancer, Hodgkin lymphoma, liver cancer, lung cancer, and oral cavity and pharyngeal cancer.
The analysis of HIV-associated cancers included 30,675 people with HIV and 66,991 without HIV. Adjusted age at cancer diagnosis was significantly younger in the HIV group (-0.57 year, 95% -0.93 to -0.21). HIV-associated cancer incidence was 497 per 1000 person-years with HIV and 215 per 1000 person-years without HIV. HIV-positive veterans had almost a twice higher rate of HIV-associated (non-AIDS) cancers (aIRR 1.84, 95% CI 1.62 to 2.09).
The "other" non-AIDS cancer analysis involved 30,675 people with HIV and 66,991 without HIV. Again, the HIV group had a significantly younger adjusted mean age at cancer diagnosis (-0.45 year, 95% CI -0.78 to -0.22). But incidence per 1000 person-years was slightly lower with HIV (4.38) than without HIV (4.80). The adjusted incidence rate ratio showed this difference was not statistically significant (aIRR 0.95, 95% CI 0.85 to 1.06).
The VACS investigators cautioned that these findings may not apply to women.
Reference
1. Althoff K, Wyatt C, Gibert C, et al. HIV+ adults are at greater risk for myocardial infarction, non-AIDS cancer, and end-stage renal disease, but events occur at similar ages compared to HIV- adults. 20th Conference on Retroviruses and Opportunistic Infections. March 3-6, 2013. Atlanta. Abstract 59.
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