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Burden of age-associated chronic comorbidities among people living with and without HIV: Years of life lost to premature mortality in British Columbia, Canada
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Life Years Lost Due to Comorbidities 2.5 Time Greater With HIV - (09/24/21)
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.
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.
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Burden of age-associated chronic comorbidities among people living with and without HIV: Years of life lost to premature mortality in British Columbia, Canada
Nanditha N1,2, Mushfiquee M1, Zhu J1, Kopec J3,4, Hogg R1,5, Montaner J1,2, Lima V1,2
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada, 2Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada, 3Arthritis Research Canada, Richmond, Canada, 4School of Population and Public Health, University of British Columbia, Vancouver, Canada, 5Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
Background: As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. To describe the burden of age-associated chronic comorbidities among PLWH compared to HIV-negative controls, we estimated Years of Life Lost due to premature mortality (YLL) related to these comorbidities.
Methods: We used data from a population-based cohort in British Columbia (BC), Canada. Antiretroviral (ART)-treated PLWH were selected, and each matched by age and sex to four HIV-negative individuals at baseline. Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012. YLL was the number of deaths multiplied by the latest available standard life expectancy at age of death published by the Global Burden of Disease Study. YLL associated with non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, non-HIV-related dementia, cardiovascular (CVD), chronic kidney (CKD), chronic liver (CLD) and chronic obstructive pulmonary diseases (COPD) for the year 2012 were measured. Cause-specific deaths were identified from the BC Vital Statistics Agency mortality dataset using International Classification of Diseases - 10 codes. For each comorbidity in each population group, non-parametric bootstrapping (10,000 bootstrap samples with replacement; sample lengths equal to the observed size of each stratum) estimated the credible intervals (CI) of YLL per 1000 people.
Results: At baseline, our matched cohort consisted of 82% males with a median age of 40 years (25th-75th percentiles: 34 to 47). In the beginning of 2012, 6449 PLWH and 29,273 HIV-negative individuals were alive with a median age of 49 years (43-56) vs. 50 (44-56).
The examined comorbidities led to a total of 1047.0 and 1970.9 years lost among PLWH and HIV-negative individuals, respectively, where PLWH experienced 2.5 times higher burden (162.4 vs. 67.3 years/1000 people). Similar to trends observed in Canada and globally, cancers and CVD contributed the highest YLL in both study populations, with cancers making up 51% (PLWH) and 62% (HIV-negative) of the aforementioned total years lost. For both comorbidities, the burden was double among PLWH compared to HIV-negative individuals (for cancers 82.6 years/1000 people [95%CI: 72.1, 93.0] vs. 41.5 [37.5, 45.5]; for CVD 32.5 [28.9, 36.1] vs. 17.3 [15.1, 19.6]). Diabetes and dementia contributed the third and fourth highest YLL among HIV-negative individuals (4.4 years/1000 people [3.3, 5.6] and 1.3 [0.6, 1.9], respectively), as did CLD and COPD among PLWH (23.1 [20.6, 25.7] and 14.1 [6.5, 21.7], respectively). Among PLWH, no deaths and, thus, no YLL associated with dementia, hypertension and osteoarthritis were identified; among HIV-negative individuals, no deaths due to osteoarthritis were observed.
Conclusions: PLWH are living longer as a result of the wide availability of ART. However, they experience disproportionate burden of age-associated chronic comorbidities and related premature mortality compared to HIV-negative individuals. The observed disparities between PLWH and HIV-negative individuals are likely multifactorial, as it may relate in part to socioeconomic and lifestyle differences, as well to some residual HIV-related inflammation, and ART-related toxicities. Our findings highlight the need to enhance prevention and management of comorbidities as part of HIV care models.
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