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Life Years Lost Due to Comorbidities 2.5 Time Greater With HIV
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International Workshop on HIV and Aging, September 23-24, 2021
By Mark Mascolini for NATAP and Virology Education
Life years lost because of age-related comorbidities proved 2.5-fold greater in middle-aged people with HIV than in matched HIV-negative controls in British Columbia, Canada [1]. Cancer and cardiovascular disease led all causes of death in both groups but twice more frequently with HIV than without HIV.
Researchers at the BC Centre for Excellence in HIV/AIDS in Vancouver noted that chronic age-associated comorbidities are a growing concern in aging HIV populations everywhere. To gauge the impact of these conditions on mortality in people with versus without HIV, they compared estimated life-years lost due to these conditions in the two groups.
The analysis involved HIV-positive people enrolled in a retrospective population-based cohort in British Columbia. Researchers selected antiretroviral-treated people at least 19 years old and followed for at least 1 year in the period 2000-2012. They matched each HIV-positive person by age and sex to 4 people without HIV in British Columbia.
Statisticians estimated life-years lost due to chronic age-associated comorbidities for the year 2012 by multiplying the number of deaths by standard residual life expectancy at the age of death. Age-related comorbidities considered were diabetes, osteoarthritis, hypertension, dementia, non-AIDS cancers, cardiovascular disease, chronic kidney disease, chronic liver disease, and chronic obstructive pulmonary disease (COPD). The investigators identified causes of death by using ICD-10 codes.
When entering the study group, people in the matched cohorts had a median age of 40 years (interquartile range [IQR] 34 to 47) and 82% were men. At the beginning of 2012, 6449 people with HIV were alive with a median age of 49 years (IQR 43 to 56), and 29,273 HIV-negative controls were alive with a median age of 50 (IQR 44 to 56). Life-years lost due to comorbidities of interest totaled 1047.0 in the HIV group and 1970.9 in the HIV-negative group. When figured as life-years lost per 1000 people, that rate was 2.5 times higher in the HIV group: 162.4 versus 67.3 per 1000.
Cancer and cardiovascular disease led all causes of life-years lost in people with and without HIV, but rates were twice higher for the HIV group: for cancer, 82.6 versus 41.5 per 1000 people; and for cardiovascular disease, 32.5 versus 17.3 per 1000 people. The next three leading causes of life-years lost in people with HIV were chronic liver disease, COPD, and chronic kidney disease. For each of these diseases, the rate of life-years lost was much higher in the HIV group than in HIV-negative controls: for chronic liver disease, 23.1 versus 1.2 per 1000 people; for COPD, 14.1 versus 0.5 per 1000 people; and for chronic kidney disease, 9.2 to versus 0.5 per 1000 people. The next cause of life-years lost in the HIV group, diabetes, proved less frequent with than without HIV: 2.1 versus 4.4 per 1000 people.
The British Columbia investigators concluded that people with HIV shoulder a "disproportionate burden of age-associated chronic comorbidities and related premature mortality compared to HIV-negative individuals." They suggested that the excess life-years lost with HIV reflect not only residual HIV-related inflammation and antiretroviral toxicities, but also socioeconomic and lifestyle differences between people with and without HIV.
Reference
1. Nanditha N, Mushfiquee M, Zhu J, et al. Burden of age-associated chronic comorbidities among people living with and without HIV: Years of life lost to premature mortality in British Columbia, Canada. International Workshop on HIV and Aging, September 23-24, 2021. Abstract 13.
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