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Rates of kidney and bone disease--and multiple
comorbidities--rising in elderly HIV group
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22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018
Mark Mascolini
In a large London clinic, the number of HIV-positive people 60 or older more than doubled from 2010 to 2017 [1]. Diagnoses of kidney disease and osteopenia/osteoporosis rose across the 8-year span, partly reflecting improved monitoring. Multiple comorbidities and drug-drug interactions became more frequent over the years.
Growing contingents of 60-and-older people with HIV raise several challenges for HIV clinicians, including rising rates of comorbidity and multiple comorbidities, treatment with complex regimens of antiretrovirals and non-HIV medications, and consequent drug-drug interactions. To explore changes in these variables in a single large HIV clinic--Guy's and St. Thomas Hospital--clinical researchers compared relevant data from 2010 to 2017.
The analysis involved people 60 or older attending the HIV clinic in September 2017, compared with people the same age in care in December 2010. Researchers used electronic medical records to gather relevant demographic and clinical data on the two groups. They used the University of Liverpool database (www.hiv-druginteractions.org) to check for drug-drug interactions.
In 2010 the clinic cared for 126 people 60 or older and 2574 younger patients (4.7% versus 95.3% of the clinic population). By 2017 those numbers and percentages changed to 300 people 60 or older and 2999 younger people (9.1% and 90.9%). Eighty-five older people in the 2010 cohort (67.5% of 126) remained in the 2017 cohort. Among the 21 older people who died between 2010 and 2017, the cause was malignancy in 38%, HIV-related disease in 21%, sepsis in 10%, and motor neuron disease in 5% (information not available for other deaths). Ages in the 60-or-older cohort ranged from 60 to 83 in 2017 and from 60 to 90 in 2017.
Median pretreatment CD4 counts in elderly people were similar in 2010 and 2017 (189 and 222, P = 0.19), results confirming persistently late HIV diagnosis in older people. The proportion of older people taking antiretrovirals rose slightly from 2010 to 2017 (94% to 99.7%). In 2017 nearly everyone 60 or older (95.3%) had a viral load below 200 copies.
From 2010 to 2017, the proportion of older people with ischemic heart disease fell significantly from 17.5% to 9.3% (P = 0.0211). Over the same period the proportion of older people with chronic kidney disease rose significantly (15.9% to 30.3%, P = 0.0016), as did the proportion with osteopenia/osteoporosis (21.4% to 36.7%, P = 0.0021). There was a trend toward a rising proportion with 3 or more comorbidities (22.2% to 30.7%, P = 0.077). By 2010 about 2 in 5 people 60 or older (40.8%) had fatty liver disease.
Among people 60 or older in 2017, almost one third (29%) took 5 or more drugs in addition to antiretrovirals, and 57% had at least 1 drug-drug interaction. Older age was associated with more non-HIV drugs (r = 0.13, P = 0.03) and more drug-drug interactions (r = 0.15, P = 0.01). Longer tenofovir disoproxil fumarate (TDF) use was associated with stage 3 or worse chronic kidney disease (odds ratio 1.06 per year longer, 95% confidence interval 1.00 to 1.11, P = 0.034). That association attenuated somewhat after adjustment for age, ethnicity, diabetes, and hypertension (P = 0.089).
Study authors stressed that people 60 or older now account for nearly 10% of their HIV population. They proposed that rising rates of certain comorbidities at least partly reflect growing awareness and screening. The researchers urged regular patient antiretroviral reviews, particularly as new agents become available, with an eye toward easing pill burden, avoiding drug-drug interactions, and improving quality of life as survival continues to increase with HIV.
Reference
1. Lee M, Bilinska J, Wallis E, et al. Beyond the 60s: changing co-morbidities in people living with HIV aged over 60 attending clinic in 2010 and 2017. AIDS 2018: 22nd International AIDS Conference, Amsterdam, Netherlands, July 23-27, 2018. Abstract TUPEB136.
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