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Prevalence of All Comorbidities Up From 2004 to 2014 in Big French Cohort
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HIV Drug Therapy, Glasgow Oct 23-26 2016
"Aquitaine, observational cohort study, southwestern France......2138 people - proportions with a high renal risk score soared from 29.9% to 50.7%.....current alcohol abuse from 3.1% to 14.3%.....hypertension from 18.8% to 56.3%..... Proportions with a 5% to 10% D:A:D coronary heart disease risk index doubled from 13.1% to 26.5%, and proportions with a D:A:D index above 10% quadrupled from 5.3% to 19.9% .....The Aquitaine team proposed that "careful HIV management, including regular monitoring and screening of the major comorbidities . . . and adequate selection of antiretroviral therapy could lead to an early management of these comorbidities" and continuous improvement in the health of people with HIV.....As PLHIV life expectancy increases, age-related comorbidities are increasing, leading to different needs in today's HIV disease management. Even for the patients in this analysis who present favourable HIV disease progression, there is still a significant increase on the comorbidity burden, and therefore a need for a more holistic, long-term, multidisciplinary approach that considers not only the ART, but also lifestyle, to manage HIV patients, potentially leading to improved outcomes."
[from Jules: here in the US all too many clinicians & doctors are not providing proper care regarding comorbidities; they all too often do not understand them, do not interact & communicate adequately with specialists, and patients are NOT aware that their doctors are unprepared because they too do not understand the dynamics of aging & comorbidities.]
Mark Mascolini
Prevalence of all measured comorbidities rose from 2004 to 2014 in French Aquitaine cohort members assessed in both years [1]. Rates of cardiovascular disease, chronic kidney disease (CKD), fractures, hypertension, and dyslipidemia all climbed over the decade of study--even while virologic response rates and CD4 counts improved dramatically.
Aquitaine researchers noted that aging of the HIV population--plus exposure to antiretrovirals and to HIV-related and classic risk factors--often lead to higher rates of comorbidities in people with than without HIV. They conducted this study to assess changes in HIV variables, comorbidities, comorbidity treatment, and risk factors in cohort members seen in 2004 and again in 2014.
Aquitaine is an ongoing observational cohort study of HIV-positive people in southwestern France. This analysis included cohort members who made one or more study visits in both 2004 and 2014. The researchers compared results of two cross-sectional analyses performed on these people. They defined cardiovascular disease as myocardial infarction, an invasive coronary procedure, or stroke; CKD meant as estimated glomerular filtration rate below 60 mL/min for at least 3 months or an ICD-10 code. They used ICD-10 codes or standard clinical values to define other comorbidities. Cancers were all non-AIDS malignancies.
The analysis focused on 2138 people, 71% of them men, 40% men who have sex with men, and 18% drug injectors. Median age measured 42.2 in 2004 and 52.2 in 2014, and 62% were 50 or older in 2014. Median body mass index rose only from 22.3 to 23.1 kg/m2 over the decade.
Proportions of cohort members with a viral load below 50 copies jumped from 51% in 2004 to 91% in 2014, while proportions with a CD4 count at 500 or more climbed from 44% to 72%.
Prevalence of all measured comorbidities rose significantly from 2004 to 2014: cardiovascular disease from 3.6% to 14.0% (P < 0.0001), CKD from 3.6% to 18.3% (P < 0.0001), fractures from 0.7% to 7.0% (P < 0.0001), diabetes from 8.4% to 18.5% (P < 0.0001), hypertension from 18.8% to 56.3% (P < 0.0001), dyslipidemia from 14.3% to 54.5% (P < 0.0001), HCV infection from 28.2% to 30.6% (P < 0.0001), HBV infection from 6.2% to 7.5% (P < 0.0001), depression from 13.5% to 14.0% (P < 0.0001), non-AIDS cancer from 2.2% to 9.4% (P < 0.0001), central nervous system events from 1.3% to 3.7% (P < 0.0001), obesity from 3.6% to 7.0% (P < 0.0001), current alcohol abuse from 3.1% to 14.3% (P < 0.0001), and active drug injecting from 0.2% to 0.5% (P = 0.0522). Current smoking prevalence changed little from 2004 to 2014 (44.0% and 43.3%). The biggest prevalence jumps involved dyslipidemia (+40.2%) and hypertension (+37.5%), and they were the most prevalent conditions.
Treatment for hypertension, dyslipidemia, kidney disease, and diabetes all rose significantly. Cardiovascular disease prevention with aspirin or clopidogrel (Plavix) also increased. Antidepressant prescribing remained stable across the study period, while use of other psychotropic drugs rose from 1.4% to 4.0% (P < 0.0001).
The proportion of people with an intermediate FRAX score indicating fracture risk (5% to 7.5%) rose from 2.1% in 2004 to 6.8% in 2014, while the proportion with a high FRAX score climbed from 0.3% to 2.9% (P < 0.0001). Proportions with a 5% to 10% D:A:D coronary heart disease risk index doubled from 13.1% to 26.5%, and proportions with a D:A:D index above 10% quadrupled from 5.3% to 19.9% (P < 0.0001). Proportions with a medium D:A:D renal risk score remained stable, while proportions with a high renal risk score soared from 29.9% to 50.7% (P < 0.0001).
The Aquitaine team proposed that "careful HIV management, including regular monitoring and screening of the major comorbidities . . . and adequate selection of antiretroviral therapy could lead to an early management of these comorbidities" and continuous improvement in the health of people with HIV.
Reference
1. Bonnet F, Le Marec F, Leleux O, Cazanave C, et al. HIV patients today and 10 years ago: do they have the same needs? Results from cross-sectional analysis of ANRS CO3 Aquitaine cohort. HIV Drug Therapy, Glasgow 2016. October 23-26, 2016. Abstract O212.
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PROGRAM ABSTRACT
HIV patients today and 10 years ago: do they have the same
needs? Results from cross-sectional analysis of ANRS CO3
Aquitaine cohort
Fabrice Bonnet1; Fabien Le Marec2; Olivier Leleux2; Charles Cazanave3; Estibaliz Lazaro1; Pierre Duffau1; Marie-Anne Vandenhende1; Patrick Mercie1; Didier Neau3 and Franc¸ois Dabis2
1Service de Me´decine Interne et Maladies Infectieus, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 2INSERM
U1219, ISPED, Universite´ de Bordeaux, Bordeaux, France. 3Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire
de Bordeaux, Bordeaux, France
Introduction: Nowadays, people living with HIV (PLHIV) live longer, due to highly effective ART. Also, due to age, risk factors exposure, ART and HIV-related factors, they are more likely to develop comorbidities, potentially requiring different, long-term healthcare management. This study aimed to describe the PLHIV characteristics, HIV markers, comorbidities and their risk factors and scores, in the same patients 10 years apart.
Materials and methods: The ANRS CO3 Aquitaine cohort prospectively collects epidemiological, clinical, biological and therapeutic data on PLHIV in the French Aquitaine region. Inclusion criterion for this analysis was ]1 visit in both calendar years. Two cross-sectional analysis were performed (2004 and 2014), regarding patient characteristics, HIV markers, the prevalence of comorbidities [chronic kidney disease (CKD), fractures, cardiovascular disease (CVD), diabetes, dyslipidaemia and hypertension, defined via ICD-10 diagnosis code, treatments or values for these comorbidities] and treatment (ART and comedication).
Results: A total of 3289 PLHIV had at least a visit registered in the cohort in 2004 and 3880 in 2014, out of which 2138 had a visit in both years. Seventy-one percent of those were male, and in 2014 the median age was 52.2 (IQR 47.658.1). When compared to 2004, in 2014 there were more patients virologically suppressed (91.5% in 2014 vs. 50.9%; p<0.0001) and 72.0% in 2014 versus 43.6% patients in 2004 had CD4 count ]500 cells/mL (p<0.0001). Table 1 shows a statistically significant increase in the prevalence of diagnosed CKD, fractures (anywhere), CVD events, hypertension, diabetes and dyslipidaemia, but also for their treatment: statins use for dyslipidaemia (9.2% in 2004 vs. 24.0% in 2014; p<0.0001); clopidogrel and aspirin use for CVD events prevention (clopidogrel: 0.8% vs. 4.1%; p<0.0001; aspirin: 0.9% vs. 8.0%; p<0.0001; 2004 and 2014, respectively). This is also reflected in the higher proportion of patients in the high risk or very high groups in the different disease risk scores for CKD, CVD and bone fracture score.
Conclusions: As PLHIV life expectancy increases, age-related comorbidities are increasing, leading to different needs in today's HIV disease management. Even for the patients in this analysis who present favourable HIV disease progression, there is still a significant increase on the comorbidity burden, and therefore a need for a more holistic, long-term, multidisciplinary approach that considers not only the ART, but also lifestyle, to manage HIV patients, potentially leading to improved outcomes.
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