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HIV-Infected in 40s Have Multiple Non-HIV Illnesses
as Often as HIV-Negatives in 50s
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
Prevalence of multiple noninfectious comorbidities was as high in 41-to-50-year-old people with HIV as in 51-to-60-year-old people without HIV, according to results of an 11,000-person case-control study in Italy [1]. People with HIV had a higher prevalence of each of the five comorbidities studied--cardiovascular disease, hypertension, diabetes, fractures, and renal failure.
This retrospective analysis involved 2854 HIV-infected, antiretroviral-experienced adults consecutively enrolled at Modena HIV outpatient clinics from 2002 to 2009. The investigators matched them 1-to-3 by age, gender, and race to HIV-negative people in the CINECA ARNO Observatory database. CINECA ARNO electronically records vital statistics, prescriptions, hospital admissions and discharges, and diagnostic tests and examinations on 11 million people across Italy.
The Modena team checked records of both cases with HIV and controls without HIV for cardiovascular disease, hypertension, type 2 diabetes, fractures, and renal failure. They defined polypathology as concurrence of two or more of these diseases. Although most HIV-infected study participants were from a metabolic clinic, they did not differ from patients in the general HIV clinic in rates of the five comorbidies considered or in the rate of multiple comorbidities.
The study group included 4244 women (37%) and had an average age of 45.8 (+/- 7.5) years. The HIV group had been infected for a median of 196 months (interquartile range [IQR] 136 to 248). They had taken nucleosides for a median of 111 months (IQR 60 to 152), protease inhibitors for a median of 38 months (IQR 0 to 74), and nonnucleosides for a median of 18 months (IQR 0 to 54). Median lowest-ever (nadir) CD4 count was 170 (IQR 66 to 263.5), and 57.5% of HIV-infected people had a nadir below 200. Viral load was undetectable in 71.3% of people with HIV.
Each of the noninfectious diseases considered was significantly more prevalent in people with HIV than in the matched controls (all P < 2.2[-16]). The HIV group also had a significantly higher prevalence of polypathology (simultaneous occurrence of two or more of the defined diseases). Polypathology prevalence was higher among people with HIV in each of the four age brackets analyzed:
-- 40 or under: 3.9% with HIV versus 0.5% without HIV
-- 41 to 50: 9.0% with HIV versus 1.9% without HIV
-- 51 to 60: 20.0% with HIV versus 6.6% without HIV
-- Over 60: 46.9% with HIV versus 18.7% without HIV
The investigators observed that the polypathology rate of 41-to-50-year-old people with HIV was similar to the rate in 51-to-60-year-olds without HIV (9.0% and 6.6%, P = 0.282). And the rate in 51-to-60-year-old people with HIV was similar to the rate in over-60 people without HIV (20.0% and 18.7%).
To identify predictors of polypathology, the researchers built a multivariate model that considered gender, age, nadir CD4 count above or below 200, and cumulative antiretroviral exposure. Four factors emerged as independent predictors of polypathology: older age (beta = 0.11, P < 0.001), male gender (beta = 0.59, P < 0.001), CD4 nadir below 200 (beta = 0.87, P < 0.001), and every additional year of antiretroviral therapy (beta = 0.01, P < 0.001).
The investigators cautioned that the ability to detect comorbidities in people with HIV may have differed in sensitivity from the ability to detect those conditions in people without HIV because of the inherently different detection methods they relied on. They also acknowledged the possibility of survival bias, in which healthier people make up a disproportionate segment of older age groups simply because they survived longer than sicker people.
With these caveats in mind, the Modena researchers called for "an aggressive approach in noninfectious comorbidity diagnosis and treatment . . . at an early age in HIV patients." They noted that "the paradox of the need of early HIV treatment and the impact of antiretroviral therapy toxicity continues."
Reference
1. Guaraldi G, Menozzi M, Zona S, et al. CD4 nadir and antiretroviral exposure predict premature polypathology onset. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_15.
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