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Kidney Disease, Diabetes Could Jump in US
MSM With HIV-But Not High Lipids

  AIDS 2020: 23rd International AIDS Conference Virtual, July 6-10, 2020
Mark Mascolini
Over the next decade chronic kidney disease (CKD) and diabetes prevalence will climb steeply among HIV-positive men who have sex with men (MSM), according to a model devised by US and Canadian researchers [1]. In contrast, the model predicts waning hypertension and hyperlipidemia prevalence in this group.
NA-ACCORD researchers previously reported modeling results suggesting the number of antiretroviral-treated MSM will expand from 210,634 in 2010 to 594,038 in 2030. Over the same period the proportion of treated MSM 60 or older could jump from 6.7% to 29.7%. The new analysis aimed to project the multimorbidity burden in MSM taking antiretrovirals through 2030.
ProjEcting Age, MultimoRbidity, and PoLypharmacy (PEARL) is a simulation model of multimorbidity among people taking antiretroviral therapy (ART) in the United States in 2009-2030. The model uses data from the NA-ACCORD collaboration for four comorbidities, CKD, type 2 diabetes (diabetes mellitus), hypertension, and hyperlipidemia. Modelers figured the prevalence of each comorbidity in white, black, and Hispanic MSM using ART in 2009-2017. PEARL estimated the future probability of each comorbidity as a function of age, calendar year, ART initiation year, CD4 count when ART began, current ART use, and prevalence of other comorbidities. Multimorbidity meant two or more comorbidities, not counting HIV infection.
The model predicted steady upswings in two comorbidities, CKD and diabetes, both from about 10% in 2010 to about 20% in 2030. Rising CKD prevalence will be much steeper in white MSM than in black or Hispanic MSM, while diabetes prevalence will climb more in blacks than in whites or Hispanics. Among MSM 60 or older, CKD prevalence could soar from 7% in 2009 to 44% in 2030.
From 2010 through 2030, hypertension prevalence and diabetes prevalence will both dwindle from about 30% to about 25%, the model projects. Hypertension prevalence is highest in black MSM and hyperlipidemia prevalence in white MSM. Across the study years, Hispanic MSM will have the lowest prevalence of CKD, diabetes, and hypertension, while blacks will have the lowest prevalence of hyperlipidemia.
In 2010 white MSM had a higher prevalence of multimorbidity than blacks or Hispanics, and the model projects that prevalence will begin leveling off in whites at about 150,000 MSM over the next decade. In contrast, multimorbidity is projected to rise in a linear fashion among both black and Hispanic MSM. By 2030 multimorbidity prevalence will be similar in Hispanics and whites, the model forecasts, and higher in blacks at above 200,000 MSM.
NA-ACCORD investigators note that the PEARL model does not yet include several important HIV comorbidities, such as cardiovascular disease, cancer, end-stage liver disease, and mental health conditions. They caution that projections could change if numbers of new HIV diagnoses change by race and age.
The researchers remind colleagues that “ending the HIV epidemic will not address the lingering challenges of comorbidities in adults with HIV who are surviving for decades.” They call for work to identify, test, and implement models of care that offer primary and secondary interventions addressing these comorbidities.
1. Kasaie P, Stewart C, Hume E, et al. Projecting the burden of multimorbidity among men who have sex with men living with HIV in the US. AIDS 2020: 23rd International AIDS Conference Virtual. July 6-10, 2020. Abstract PEC0452.