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Proportion of US HIV Patients With 3 or More
Comorbidities Will Rise 4-Fold by 2035
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HIV Drug Therapy, Glasgow 2016
Mark Mascolini
Among US antiretroviral-treated people, the proportion with three or more noncommunicable diseases (NCDs) will quadruple--from 11% to 44%--between 2015 and 2035, according to a modeling study at the Imperial College London [1]. Over the same period, average age of people taking antiretrovirals will jump from 48.9 to 57.8, the model projects.
Everyone knows that HIV populations are aging and acquiring comorbidities along the way. The Imperial College team noted that country-level projections of NCD rates are needed to help health systems prepare for these changes. This analysis focused on aging and NCD projections across the United States.
The researchers started with clinical data on 3748 antiretroviral-treated commercially insured US residents. They built their model using 2005-2010 data on this nationally representative sample as they aged and developed common NCDs including cardiovascular disease, diabetes, chronic kidney disease (CKD), and non-AIDS cancers. In simulating development of these NCDs, the model accounted for the impact of certain conditions on risk of other conditions. Then the London team scaled modeling results to national HIV surveillance and program data. The researchers validated the model on another set of US HIV patients on treatment from 2010 to 2015.
The model predicted that the average age of antiretroviral-treated US people will climb from 48.9 in 2015 to 57.8 in 2035. Over that same span, the proportion of people 50 or older will almost double from 39% to 74%. The proportion of treated people with no NCDs will slip from 29% in 2015 to 11% in 2035. In the same time, the proportion with three or more NCDs will quadruple from 11% to 44%.
Cardiovascular disease (including myocardial infarction, stroke, hypertension, and dyslipidemia), plus diabetes and non-AIDS cancers, will drive the rising toll of NCD across the United States. The proportion of people affected by cardiovascular disease alone, the model projects, will jump from 63% in 2015 to 85% in 2035.
The model calculated that 320,535 antiretroviral-treated US patients had cardiovascular disease in 2015. That number will balloon to 447,822 in 2025 and to 446,331 in 2035. Respective projected numbers of people with diabetes are 62,885, 105,465, and 123,852, and numbers with non-AIDS cancer 71,904, 130,743, and 158,098.
A modeling study by some of the same researchers, collaborating with University College London and the ICONA Cohort group in Italy, projected that the average age of antiretroviral-treated people in Italy will leap from 46.1 in 2015 to 58.8 in 2035, while the proportion with one or more NCD will rise from 64% to 89% [2]. The main drivers of increasing NCD rates in Italy will be cardiovascular disease, diabetes, and CKD.
The researchers concluded that antiretroviral-treated people will endure a growing burden of non-AIDS comorbidities as they age and that multimorbidity will complicate HIV management because of drug-drug interactions. They recommended "multidisciplinary patient management and enhanced communication between HIV specialists, geriatric medicine and primary care."
References
1. Smit M, Cassidy R, Hallett T. Quantifying the future clinical burden of an ageing HIV-positive population the USA: a mathematical modelling study. HIV Drug Therapy, Glasgow 2016. October 23-26, 2016. Abstract P157.
2. Smit M, Cassidy R, Cozzi-Lepri A, et al. Quantifying the future clinical burden of an ageing HIV-positive population in Italy: a mathematical modelling study. HIV Drug Therapy, Glasgow 2016. October 23-26, 2016. Abstract P156.
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