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Comorbidity Rates Higher in Over-49 HIV Group Than in Matched HIV Negatives
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
investigators proposed that "the contrast in prevalence estimates observed supports the hypothesis that accelerated aging in the HIV population may lead to excess age-related morbidity."
A large US study of people over 49 years old found much higher rates of numerous non-HIV diseases and disorders in people with HIV than in age- and gender-matched HIV-negative people [1]. Disease and disorder rates were also higher in the 50-and-older HIV group than in a younger HIV-positive population.
GlaxoSmithKline investigators analyzed noninfectious and infectious comorbidity rates in HIV-positive people 50 years old or older in the Impact National Benchmark Database, a US healthcare claims database including 82 million deidentified individuals who received care from 1997 through 2009. The analysis focused on people with full pharmacy benefits who had continuous follow-up of at least 6 months as of January 1, 2009. The GSK team compared comorbidity rates in the 50-and-older HIV group with rates in two groups: (1) age- and gender-(but not race-) matched 50-and-older people without HIV and (2) 18-to-49-year-olds with HIV.
The study included 34,766 HIV-infected people who were 50 or older, 104,298 HIV-negative 50-or-older people, and 74,476 HIV-infected people between 18 and 49. In the 50-and-older HIV group, 78% were men and 74% were between 50 and 59. Only 55% of the 50-and-older HIV group had ever taken antiretrovirals, compared with 44% of the younger HIV group. The younger HIV group had a higher proportion of women than the older HIV group (31% versus 22%). The older and younger age groups were similar in proportions with a CD4 count below 200 (16% and 15%), a viral load below 400 copies (53% and 50.5%), and a viral load above 100,000 copies (6% versus 8%).
Compared with the 50-and-over HIV-negative group, 50-and-older people with HIV had higher rates of many comorbidities and disorders. Data in parentheses are prevalence ratios (PR) and 95% confidence intervals (CI):
-- Ischemic heart disease: 25% versus 20% (PR 1.30, 95% CI 1.26 to 1.32)
-- Congestive heart failure: 11% versus 5% (PR 2.28, 95% CI 2.19 to 2.37)
-- Peripheral vascular disorders: 7% versus 4% (PR 1.96, 95% CI 1.87 to 2.06)
-- Coagulopathy (bleeding disorders): 7% versus 1.5% (PR 4.62, 95% CI 4.35 to 4.92)
-- Stroke: 4% versus 2% (PR 2.36, 95% CI 2.21 to 2.53)
-- Hypertension: 43% versus 35% (PR 1.25, 95% CI 1.23 to 1.27)
-- High lipids: 53% versus 41% (PR 1.32, 95% CI 1.30 to 1.33)
-- Diabetes: 18% versus 12% (PR 1.48, 95% CI 1.43 to 1.52)
-- Renal failure: 6% versus 1% (PR 4.49, 95% CI 4.21 to 4.80)
-- Liver disease: 13% versus 3% (PR 4.94, 95% CI 4.72 to 5.17)
-- Bone loss/vitamin D deficiency: 15% versus 10% (PR 1.51, 95% CI 1.47 to 1.56)
-- Weight loss: 0.7% versus 0.07% (PR 11.0, 95% CI 8.4 to 14.4)
-- Metastatic cancer: 3% versus 1% (PR 2.79, 95% CI 2.56 to 3.04)
-- Tumor without metastasis: 13% versus 7% (PR 1.92, 95% CI 1.86 to 2.00)
-- Lymphoma: 3% versus 0.6% (PR 5.53, 95% CI 5.00 to 6.12)
-- Depression: 18% versus 8% (PR 2.29, 95% CI 2.22 to 2.36)
-- Alcohol abuse: 4% versus 2% (PR 2.21, 95% CI 2.05 to 2.38)
-- Drug abuse: 4% versus 1% (PR 4.90, 95% CI 4.49 to 5.34)
-- Psychoses: 1.3% versus 0.4% (PR 3.19, 95% CI 2.80 to 3.65)
Four coinfections assessed--hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus (HSV), and cytomegalovirus (CMV)--were more prevalent in the HIV group than the HIV-negative group.
Compared with the 18-to-49-year-olds with HIV, the older HIV group had higher rates of the following diseases or disorders (with prevalence ratios in parentheses):
-- Ischemic heart disease: 25% versus 11% (PR 2.30, 95% CI 2.23 to 2.36)
-- Congestive heart failure: 11% versus 3.5% (PR 3.26, 95% CI 3.11 to 3.42)
-- Peripheral vascular disorders: 7% versus 2% (PR 4.53, 95% CI 4.23 to 4.85)
-- Coagulopathy (bleeding disorders): 7% versus 4% (PR 1.86, 95% CI 1.77 to 1.96)
-- Stroke: 4% versus 1% (PR 4.06, 95% CI 3.74 to 4.43)
-- Hypertension: 43% versus 19.5% (PR 2.22, 95% CI 2.18 to 2.26)
-- Abnormal lipids: 53% versus 36% (PR 1.50, 95% CI 1.48 to 1.52)
-- Metastatic cancer: 3% versus 1% (PR 3.11, 95% CI 2.82 to 3.43)
-- Tumor without metastasis: 13% versus 4% (PR 2.89, 95% CI 2.76 to 3.01)
-- Lymphoma: 3% versus 1.5% (PR 2.11, 95% CI 1.94 to 2.30)
-- Depression: 18% versus 17% (PR 1.07, 95% CI 1.04 to 1.10)
-- Alcohol abuse: 4% versus 3% (PR 1.13, 95% CI 1.05 to 1.20)
Compared with the under-50 HIV group, older people with HIV had a higher prevalence ratio for HCV (2.6) and CMV (1.9) but a lower prevalence ratio for HSV (0.7).
In the 50-and-older HIV group, 10,243 people had CD4 count data available. Median nearest CD4 counts lay below 350 in people with metastatic cancer, lymphoma, weight loss, and coagulopathy.
The GSK researchers noted several limitations to their analysis, including missing information on race, disease stage, and HIV transmission route. They cautioned that the findings may not apply to very elderly populations or low-income populations without health coverage (everyone in this analysis had full pharmacy benefits, and three quarters were between 50 and 59). The investigators proposed that "the contrast in prevalence estimates observed supports the hypothesis that accelerated aging in the HIV population may lead to excess age-related morbidity."
Reference
1. Nkhoma E, Vannappagari V, Mynepalli L, Logie J. Comorbidities and coinfections among HIV patients 50 years and older. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_16.
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