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HIV DIFFERENTIALLY IMPACTS AGE-RELATED COMORBIDITY BURDEN AMONG US WOMEN AND MEN
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CROI 2021 March 6 Reported by Jules Levin
When HIV+ men & women reach 70 years old the rates of having 5 or more comorbidities jump a lot higher . For HIV+ women these rates jump a lot higher after 60 years of age. These big jumps occur for HIV+ men too after 60 but the jumps are bigger for HIV+ women.
I draw your attention to this graph where you can see women >70 with HIV have almost double the rate of 5 comobidities compared to HIV-neg women >70. The same can be said for HIV+ men compared to HIV-neg men >70. But the rates of having 5 or more comorbidities were higher for HV+ women than HIV+ men over 70. Jules
Lauren F. Collins1, Frank Palella2, Cyra C. Mehta1, JaNae Holloway1, Valentina Stosor2, Jordan Lake3, Todd Brown4, Kathryn Anastos5, Seble Kassaye6, Adaora Adimora7, Mirjam-Colette Kempf8, Susan L. Koletar9, Phyllis Tien10, Igho Ofotokun1, Anandi N. Sheth1
1Emory University, Atlanta, GA, USA, 2Northwestern University, Chicago, IL,
USA, 3University of Texas at Houston, Houston, TX, USA, 4The Johns Hopkins University, Baltimore, MD, USA, 5Albert Einstein College of Medicine, Bronx, NY, USA, 6Georgetown University, Washington, DC, USA, 7University of North Carolina at Chapel Hill, Chapel Hill, NC, USA, 8University of Alabama at Birmingham, Birmingham, AL, USA, 9The Ohio State University, Columbus, OH, USA, 10University of California San Francisco, San Francisco, CA, USA
Background: Age-related non-AIDS comorbidities (NACM) occur earlier and more frequently among people with HIV (PWH) than HIV-negative (HIV-) peers. HIV may also differentially impact the burden of NACM experienced by women vs men.
Methods: PWH and HIV- participants followed in the MACS/WIHS Combined Cohort Study (MWCCS) since 2008/2009 (when >80% of male/female participants used antiretroviral therapy) were included with outcomes measured up to 03/2019. Age, covariates, NACM prevalence, and NACM burden (total number out of 10) were summarized as of last observation. Unadjusted and adjusted (race, body mass index [BMI], smoking, drinking, crack/cocaine, socioeconomic status) linear regression models assessed the effects of HIV serostatus, age and sex on NACM burden.
Results: Women (2316 PWH, 922 HIV-) vs men (1452 PWH, 1239 HIV-) had a median age of 51 vs 58 years, median BMI of 30 vs 26 kg/m2, 65% vs 25% were Black, and 78% vs 32% had income <150% of the federal poverty level, respectively. Overall, individual NACM prevalence ranged from 9-71%, and the distribution for women/men was: hypertension (68%/75%), psychiatric illness (55%/58%), dyslipidemia (41%/64%), liver (34%/38%), bone (42%/19%), lung (38%/10%) disease, diabetes (24%/17%), cardiovascular (15%/15%), kidney (14%/15%) disease, and cancer (7%/12%). Mean NACM burden was higher among women vs men (3.4 vs 3.2, p=0.015). In the unadjusted model, the estimated mean difference in NACM burden was significantly greater for women vs men in every age strata among PWH (all p<0.05): +0.33 (<40y), +0.37 (40-49y), +0.38 (50-59y), +0.66 (60-69y), +0.62 (≥70y); however, differed for women vs men by age strata among HIV- participants: +0.52 (<40y, p=0.01), -0.07 (40-49y, p=0.72), +0.88 (50-59y, p<0.01), +1.39 (60-69y, p<0.01), +0.33 (≥70y, p=0.46) [HIV*age*sex interaction, p<0.01]. In the adjusted model, findings were attenuated but HIV and age still significantly modified the estimated NACM burden by sex (HIV*age*sex interaction, p=0.038, Figure).
Conclusion: The prevalence and burden of NACM was high in the MWCCS among men and women with or at-risk for HIV, particularly for hypertension, psychiatric illness, dyslipidemia, liver, and bone disease. NACM burden was higher in women vs men, particularly among PWH, and the distribution of specific NACM prevalence differed by sex. Given HIV is associated with differential effects on age-related comorbidities by sex, HIV serostatus- and sex-specific strategies for NACM screening and prevention are needed.
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