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Higher Rates of Heart Disease, Diabetes,
Neuropathy in Older Men With vs Without HIV
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Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle
Mark Mascolini
HIV-negative men in a large Australian comparison reported more current smoking and alcohol use than HIV-positive men, yet the HIV group had higher prevalence of thrombosis, heart disease, diabetes, and neuropathy than the negative group [1].
Aging of HIV populations across the globe continues to inspire new research on age-associated conditions in people with HIV. More than half of HIV-positive Australians are now older than 50, according to University of New South Wales investigators who conducted this study, and almost all are men who have sex with men (MSM). As in other countries, MSM in Australia engage in many behaviors that may boost their risk of age-related comorbidities, including smoking and frequent use of alcohol and recreational drugs. To explore rates of age-related comorbidities in MSM with versus without HIV, researchers started the APPLES study--the Australian Positive and Peers Longevity Evaluation Study.
APPLES recruits HIV-positive and negative MSM age 55 and older to compare key demographics, lab markers, self-reported comorbidities, and biomarkers by HIV status. For certain comorbidities and biomarkers, the researchers adjust HIV status a priori for age, smoking, and body mass index.
So far APPLES has recruited 228 men with HIV and 218 without HIV. Median age of the whole group stands at 63 (interquartile range 59 to 67). A higher proportion of HIV-negative men were obese (24% vs 14%). All but 3 HIV-positive men were taking antiretroviral therapy, and 98% had a viral load below 200 copies.
The comorbidity analysis involves 193 men with HIV and 206 without HIV. Compared with HIV-negative men, HIV-positive men had a higher proportion of ever-smokers (60.6% vs 48.9%) but a lower proportion of current smokers (19.5% vs 23.9%) (P = 0.029 for smoking status overall), a lower median number of standard alcoholic drinks per week (3 versus 6, P = 0.002), a higher proportion reporting recent recreational drug use (41.5% vs 24.2%, P < 0.001), and a nonsignificantly higher proportion reporting recent drug injecting (4% vs 1.1%, P = 0.106). Self-reported exercise rates were similar in the two groups.
A significantly lower proportion of men with HIV had high low-density lipoprotein cholesterol (15% versus 24%, P = 0.028), but a significantly higher proportion had high triglycerides (37% versus 17%, P < 0.001). Median levels of the inflammation marker hsCRP and the kidney function marker cystatin C were significantly higher in the HIV group (P < 0.001 for both).
Prevalence of 5 self-reported conditions was significantly higher in men with than without HIV: thrombosis (about 10% vs 4%), diabetes (about 15% vs 8%), heart disease (about 20% vs 12%), neuropathy (about 22% vs 1%), and shingles (about 32% vs 16%). After statistical adjustment, HIV-positive MSM had significantly greater odds of diabetes (adjusted odds ratio [aOR] 2.03, P = 0.03), thrombosis (aOR 3.10, P = 0.006), neuropathy (aOR 36.8, P < 0.001), and shingles (aOR 2.33, P < 0.001) and borderline greater odds of heart disease (aOR 1.77, P = 0.056).
The APPLES team believes their findings suggest that older men with HIV "indeed experience some non-communicable diseases at higher rates compared to HIV-negative MSM of similar age, despite smoking and other traditional risk factors." They stress the importance of assembling an appropriate HIV-negative control group when evaluating HIV comorbidity rates and risks in people with HIV.
Reference
1. Petoumenos K, Huang R, Hoy J, et al. APPLES—The Australian positive & peers longevity evaluation study. Conference on Retroviruses and Opportunistic Infections (CROI), February 13-16, 2017, Seattle. Abstract 670.
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