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HIV+ Women Have Higher Burden of Comorbidities vs HIV- Women / Accelerated-Earlier by 10 Years
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Download the PDF here
Download the PDF here
Download the PDF here
- In HIV 80 is the new 70 - disparities in care & longevity, reduced life expectancy, quality of life - gets ignored, little discussion. AGEISM
Increasing Evidence that women living with HIV have a high burden of non-AIDS comorbidities....."In conclusion, WLWH living in the United States experienced a high overall burden of age-associated NACMs compared with HIV-seronegative counterparts".........in WIHS Overall, NACM burden was high in the cohort, but higher in WLWH and in certain age groups (WLWH had a higher mean NACM number than HIV-seronegative women and higher prevalence of psychiatric illness, dyslipidemia, non-AIDS cancer, kidney, liver, and bone disease). Non-HIV traditional risk factors were significantly associated with NACM burden in WLWH and should be prioritized in clinical guidelines for screening and intervention to mitigate comorbidity burden in this high-risk population. In medical 64 million person database with 10,000 HIV+ women, HIV+ women had significantly higher prevalence of hypertension (prevalence ratio [PR], 1.37; 95% confidence interval [CI], 1.35-1.40), diabetes (PR, 1.48; 95% CI, 1.43-1.53), cardiovascular disease (PR 2.05; 95% CI, 1.96-2.15), and lung disease (PR 2.06; 95% CI, 2.01-2.11) than women without HIV.
Human immunodeficiency virus infection accelerates the development of age-related comorbidities, with research showing that the presence of 2 or more conditions, such as diabetes mellitus, hypertension, cardiovascular disease, kidney disease, and bone fractures, may occur about a decade earlier in persons living with HIV compared with individuals without HIV [2]. A disproportionate burden of non-AIDS comorbidities has been described among women living with HIV
2 studies published in 2020 reported women with HIV had higher rates of comorbidities (NACMs) that women without HIV. The WIHS study found: WLWH had a higher mean NACM number than HIV-seronegative women (3.6 vs 3.0, P < .0001) and higher prevalence of psychiatric illness, dyslipidemia, non-AIDS cancer, kidney, liver, and bone disease (all P < .01). Prevalent hypertension, diabetes, and cardiovascular and lung disease did not differ by HIV serostatus. Estimated NACM burden was higher among WLWH versus HIV-seronegative women in those aged 40-49 (P < .0001) and ≥60 years (P = .0009) (HIV x age interaction, P = .0978). In adjusted analyses, NACM burden was associated with HIV, age, race, income, BMI, alcohol abstinence, cigarette, and crack/cocaine use. In WIHS HIV-negative women suffered similar lifestyles & behavior so had similar high risk for poor health which likely had something to do with their finding that prevalent hypertension, diabetes &cardiovascular & lung disease dit not differ by HIV status. But in the 2nd study here below they found "WLWH had significantly higher prevalence of hypertension (prevalence ratio [PR], 1.37; 95% confidence interval [CI], 1.35-1.40), diabetes (PR, 1.48; 95% CI, 1.43-1.53), cardiovascular disease (PR 2.05; 95% CI, 1.96-2.15), and lung disease (PR 2.06; 95% CI, 2.01-2.11) than women without HIV." Other studies have found older aging women with HIV suffer worse cognitive function, physical function & more exhaustion, and worse quality life. Women with HIV may be more cognitively impaired: https://www.natap.org/2018/AGE/AGE_25.htm This disparity has been part of the HIV landscape for 20 years and it persists. Yet despite calls to address inequities today this unique issue gets little discussion. Its tied at the core to the aging & HIV problem. All HIV+ >65 are suffering riskier accelerated aging, premature comorbidities & premature physical & mental impairments & disabilities. Many of us feel 80 when we are 70. We do NOT have an HIV healthcare that meets our needs, we ARE the majority & soon 70% will be over 50. Right now already 70% are >50 in NY & SF. The Kaiser group reported by Julia Marcus published in 2020 they found a 9 years reduced life expectancy in HIV+ & even 6.8 years for those starting ARTs with higher CD4s. Many in the group had poor social determinants of health. But a high premature burden of comorbidities is expected by many to reduce life expectancy as well. - Jules Levin
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The Prevalence and Burden of Non-AIDS Comorbidities Among Women Living With or at Risk for Human Immunodeficiency Virus Infection in the United States
Clinical Infectious Diseases 02 March 2020 - Lauren F. Collins,1,2, Anandi N. Sheth,1,2 C. Christina Mehta,3 Susanna Naggie,4 Elizabeth T. Golub,5 Kathryn Anastos,6 Audrey L. French,7 Seble Kassaye,8 Tonya Taylor,9 Margaret A. Fischl,10 Adaora A. Adimora,11 Mirjam-Colette Kempf,12 Frank J. Palella Jr,13 Phyllis C. Tien,14,15 and Ighovwerha Ofotokun1,2
Our study compared NACMs in WLWH with demographically similar HIV-seronegative women recruited in the WIHS based on sociobehavioral characteristics associated with risk of HIV acquisition [18]. In our study, HIV-seronegative women had significantly higher BMI, blood pressure, and substance use compared with WLWH. It is well established that these characteristics predispose to age-related comorbidities [39]. Therefore, it is possible that the observed differences in NACM burden by HIV serostatus may be even greater if WLWH were compared with HIV-seronegative women from a more generalized population.
Clinical care guidelines may consider additional emphasis on screening and intervention of social determinants of health and modifiable lifestyle factors to mitigate comorbidity risk in aging WLWH, including those aged less than 50 years, in whom NACM burden is already higher than in their HIV-seronegative counterparts.
Abstract
Background
The prevalence and burden of age-related non-AIDS comorbidities (NACMs) are poorly characterized among women living with HIV (WLWH).
Methods
Virologically suppressed WLWH and HIV-seronegative participants followed in the Women's Interagency HIV Study (WIHS) through at least 2009 (when >80% of WLWH used antiretroviral therapy) were included, with outcomes measured through 31 March 2018. Covariates, NACM number, and prevalence were summarized at most recent WIHS visit. We used linear regression models to determine NACM burden by HIV serostatus and age.
Results
Among 3232 women (2309 WLWH, 923 HIV-seronegative) with median observation of 15.3 years, median age and body mass index (BMI) were 50 years and 30 kg/m2, respectively; 65% were black; 70% ever used cigarettes. WLWH had a higher mean NACM number than HIV-seronegative women (3.6 vs 3.0, P < .0001) and higher prevalence of psychiatric illness, dyslipidemia, non-AIDS cancer, kidney, liver, and bone disease (all P < .01). Prevalent hypertension, diabetes, and cardiovascular and lung disease did not differ by HIV serostatus. Estimated NACM burden was higher among WLWH versus HIV-seronegative women in those aged 40-49 (P < .0001) and ≥60 years (P = .0009) (HIV x age interaction, P = .0978). In adjusted analyses, NACM burden was associated with HIV, age, race, income, BMI, alcohol abstinence, cigarette, and crack/cocaine use; in WLWH, additional HIV-specific indices were not associated, aside from recent abacavir use.
Conclusions
Overall, NACM burden was high in the cohort, but higher in WLWH and in certain age groups. Non-HIV traditional risk factors were significantly associated with NACM burden in WLWH and should be prioritized in clinical guidelines for screening and intervention to mitigate comorbidity burden in this high-risk population.
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Burden of Hypertension, Diabetes, Cardiovascular Disease, and Lung Disease Among Women
Living With Human Immunodeficiency Virus (HIV) in the United States
Clinical Infectious Diseases 22 August 2020 - Morgan Birabaharan,1 Andrew Strunk,2 and Thomas C. S. Martin1
We performed a cross-sectional analysis using a multi-health system electronic medical record analytics platform (Explorys; IBM Watson Health, Cambridge, MA, USA). At present, the database contains 64 million patients, representing 15% of the population across all 4 US census regions. Patients with all types of insurance as well as those who are self-pay are represented.
We identified 10 590 WLWH (63% Black, 89% <65 years) and 14 546 020 HIV-seronegative women controls (77% White, 14% Black, 71% <65 years). Hypertension (49% vs 31%), diabetes (22% vs 12%), cardiovascular disease (13% vs 7%), and lung disease (36% vs 17%) were more common in WLWH in the overall cohort as well as within all age subgroups (Table 1). After adjusting for age and race, WLWH had significantly higher prevalence of hypertension (prevalence ratio [PR], 1.37; 95% confidence interval [CI], 1.35-1.40), diabetes (PR, 1.48; 95% CI, 1.43-1.53), cardiovascular disease (PR 2.05; 95% CI, 1.96-2.15), and lung disease (PR 2.06; 95% CI, 2.01-2.11) than women without HIV.
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Collins et al [4] also showed that non-AIDS comorbidities among women living with or at risk for HIV infection were associated with risk factors of comorbidity burden that are well established in the general population and the broader population with HIV, including older age, lower income, higher body mass index, and reported tobacco or crack/cocaine use. These results highlight the need for interventions that target modifiable risk factors among women living with HIV using culturally sensitive approaches, including intensification of primary prevention programs, smoking cessation, and substance-abuse disorder treatment services.....The data presented by Collins et al provide a compelling rationale for implementing and testing interventions aimed at attenuating the effects of known risk factors of comorbidity burden among women living with HIV. These data should motivate various agencies and organizations to dedicate additional funding to allow researchers to continue to unravel these mysteries with the aim of helping to alleviate suffering for those afflicted by a chronic disease without a cure.
Recent studies indicate that several factors may contribute to the observed sex-related differences in HIV infection and outcomes, including biological features such as hormonal, immunologic, genetic, and epigenetic factors, as well as sociobehavioral determinants [10]. For instance, compared with men, women exhibit lower levels of HIV viremia during the early stages of HIV infection [11]. Furthermore, women on chronic ART appear to have less cell-associated HIV RNA, and lower plasma HIV presence by single-copy assay [12], perhaps related to the role of estrogen receptor in maintaining virus latency [13]. Enhanced interferon-ɑ production of plasmocytoid dendritic cells from women results from estrogen receptor signaling and X-chromosome complement [14]. T cells have higher expression of inflammatory and cytotoxic pathways upon re-stimulation, with estrogen likely playing a role in overexpressing related immune genes [15]. After initiation of ART, restricted declines in C-reactive protein have been reported in women compared with men living with HIV [16]. Additional studies are needed to improve our understanding of key drivers of sex-specific differences in non-AIDS comorbidities in people living with HIV.
Editorial - Bearing the Burden of Non-AIDS Comorbidities: This Is What Women Aging With Human Immunodefiency Virus Look Like
Clinical Infectious Diseases, 02 March 2020- Moises A. Huaman and Carl J. Fichtenbaum
Non-AIDS comorbidities are leading causes of death in people living with human immunodeficiency virus (HIV), particularly among individuals on chronic antiretroviral therapy (ART) [1]. Human immunodeficiency virus infection accelerates the development of age-related comorbidities, with research showing that the presence of 2 or more conditions, such as diabetes mellitus, hypertension, cardiovascular disease, kidney disease, and bone fractures, may occur about a decade earlier in persons living with HIV compared with individuals without HIV [2]. A disproportionate burden of non-AIDS comorbidities has been described among women living with HIV compared with their male counterparts [3]. In this issue of Clinical Infectious Diseases, Collins et al [4] report on the prevalence and burden of non-AIDS comorbidities among participants of the Women's Interagency HIV Study (WIHS), a well-characterized cohort of women with and without HIV infection from 11 cities across the United States. Among 2309 women living with HIV and 923 women without HIV, the investigators found that women living with HIV had an overall higher number of non-AIDS comorbidities (3.6 vs 3.0) and a higher prevalence of psychiatric illnesses, non-AIDS cancer, dyslipidemia, and kidney, liver, and bone disease. These findings have significant implications when designing and prioritizing targeted interventions to prevent and control comorbidity burden in populations with HIV, as women account for about one-quarter of adults with HIV in the United States [5], and represent about half of people living with HIV globally [6]. Furthermore, because women have been traditionally underrepresented in HIV-related research [7], these results from the WIHS cohort underscore the need for continued efforts to ensure adequate representation of women and minority populations in translational and clinical HIV research. It is important to highlight that 65% of women included in the study by Collins et al were black and 20% were Hispanic, a breakdown comparable to the distribution of race and ethnicity among new HIV diagnoses in the United States [5].
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