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Non-AIDS Illness Rate Higher in Older HIV-Positives Than in Similar non-HIV Group
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XIX International AIDS Conference, July 22-27, 2012, Washington, DC
Mark Mascolini
Among people over 44 years old in a Netherlands HIV cohort, rates of 8 noncommunicable non-AIDS diseases were significantly higher than in an HIV-negative group with similar risk behavior [1]. Both longer HIV duration and longer antiretroviral duration independently boosted odds of non-AIDS comorbidities in the HIV group, as did heavier smoking.
Research in many cohorts indicates that non-AIDS illnesses often occur at earlier ages in HIV-positive people than in HIV-negative comparison groups or the general population. Researchers with the AGEhIV Cohort Study Group in the Netherlands conducted this comparison of HIV-positive people over 44 years old and a group of HIV-negative people attending a public sexual health clinic and so similar to the HIV group in risk behavior.
The 489-person HIV cohort included a higher proportion of men than the 452-person HIV-negative group (89.4% versus 83.8%, P = 0.013) and a nonsignificantly higher proportion of gay or bisexual men (68.5% versus 63.5%, P = 0.105). The HIV group had a lower proportion of Dutch members than the group without HIV (75.1% versus 82.1%, P = 0.037). Median age was slightly but significantly higher in the HIV group (52.9 versus 51.5, P = 0.009).
People with HIV had documented infection for a median of 12.2 years (interquartile range [IQR] 6.5 to 17.3). The group had taken antiretrovirals for almost as long, a median of 11.2 years (IQR 5.5 to 14.9). CD4 count in the year before enrollment in the AGEhIV Cohort averaged 573, and nadir CD4 count averaged 210. Most people with HIV (91.2%) were taking antiretroviral therapy, and 85% had a viral load below 40 copies in the year before enrollment. Only 30% of these people had an AIDS diagnosis.
The HIV group included a higher proportion of current smokers (31.9% versus 22.9%, P = 0.006), and they smoked more than the HIV-negative group (median 7.6 versus 3.0 pack-years, P < 0.001). The HIV-negative group had a higher proportion of alcohol abusers (6.9% versus 3.5%, P = 0.019), but similar proportions (17.5% without HIV and 17.6% with HIV) used marijuana, cocaine, and/or ecstasy (MDMA).
Three quarters of the HIV group (74.4%) had one or more self-reported age-associated non-communicable comorbidities (AANCC), compared with 60.4% in the HIV-negative group, a highly significant difference (P < 0.001). Average numbers of AANCCs were 1.4 in the HIV group and 0.9 in the HIV-negative group (P < 0.001). Compared with HIV-negative people, those with HIV had significantly higher rates of eight AANCCs:
-- Hypertension: about 43% versus 30%, P < 0.0001
-- Non-AIDS cancer: about 12% versus 6%, P = 0.001
-- Angina pectoris: about 6% versus 4%, P = 0.005
-- Myocardial infarction: about 5% versus 1%, P = 0.003
-- Peripheral arterial insufficiency: about 4% versus <1%, P = 0.003
-- Chronic liver disease: about 8% versus 1%, P < 0.0001
-- Cerebrovascular disease: about 5% versus 1%, P = 0.022
-- Reduced renal function: about 5% versus 1%, P = 0.006
Dividing study participants into 5 age groups, the AGEhIV investigators found that similar numbers of cumulative AANCCs appeared to occur 5 years earlier in HIV-positive people than in HIV-negative people. Average numbers of AANCCs were higher with HIV in every age group:
-- 45-50: 0.89 HIV+ versus 0.68 HIV-
-- 50-55: 1.35 HIV+ versus 0.80 HIV-
-- 55-60: 1.52 HIV+ versus 1.03 HIV-
-- 60-65: 1.65 HIV+ versus 1.15 HIV-
-- 65+: 2.04 HIV+ versus 1.47 HIV-
After adjustment for age, gender, and pack-years of smoking, logistic regression analysis determined that HIV infection doubled the odds of comorbidity (odds ratio 2.1), while every 5 years of age raised the odds about 50% and every 5 pack-years of smoking inflated the odds about 10%.
Adding estimated duration of HIV infection to the model did not affect the impact of smoking pack-years or age, but every 5 years of HIV duration upped the odds of comorbidity 16%. Adding duration of antiretroviral therapy to the model negated the impact of HIV duration, as every 5 years of antiretroviral treatment raised the odds of comorbidity 35%. Again, the impact of smoking pack-years and age remained unaffected in this new model.
Finally, the researchers calculated the impact of a metric called AGE, for advanced glycation endpoints representing nonenzymatic glycation of proteins, lipids, and DNA. They believe AGE accumulation is influenced by age, smoking, inflammation, renal function, and diabetes, and that the AGE level increases with chronological age. People with HIV have higher AGE values than HIV-negative contemporaries. Every 10% higher than expected AGE value in these HIV-positive people raised the comorbidity risk 8% without affecting the impact of antiretroviral duration, smoking pack-years, or age itself.
The separate impacts of longer HIV duration and longer antiretroviral duration on comorbidity might be expected, the investigators suggested, in a cohort with very few untreated people.
Reference
1. Schouten J, Wit FW, Stolte IG, et al. Comorbidity and ageing in HIV-1 infection: the AGEhIV Cohort Study. XIX International AIDS Conference. July 22-27, 2012. Washington, DC. Abstract THAB0205.
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