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Younger Age at Diagnosis of CVD and HTN With
HIV Suggests Premature Aging
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AIDS 2022, July 29-August 2, Montreal
Mark Mascolini
Cardiovascular disease (CVD) and hypertension (HTN) arose at a younger age in UK adults with HIV than in propensity score-matched people without HIV infection [1]. Because researchers matched the HIV-positive and -negative groups for demographics, socioeconomic status, lifestyle behaviors, and comorbidities, they believe earlier CVD and hypertension in the HIV group indicates premature aging with HIV infection.
Researchers at England's University of Birmingham and coworkers at other centers noted that previous studies show higher rates of age-related morbidities in HIV populations, including CVD, hypertension, diabetes, dementia, and bone, liver, and kidney diseases [2,3]. The investigators used the IQVIA Medical Research Database, a UK database of primary healthcare records, to select HIV-positive and -negative participants at least 18 years old between January 2000 and January 2020.
For each outcome—newly diagnosed CVD, hypertension, diabetes, and chronic kidney disease (CKD)—the researchers matched each HIV-positive person to an HIV-negative person on a propensity score including age at study entry, sex, ethnicity, deprivation score, smoking status, substance use (alcohol, cocaine, other drugs), body mass index, antilipid drug use, depression, anxiety, and severe mental illness. Linear regression adjusted for all variables in the propensity score except study-entry age determined whether age at comorbidity diagnosis differed between people with and without HIV.
The CVD study group had 8880 people with HIV and 8880 without, the hypertension group 8520 and 8520, the diabetes group 8926 and 8926, and the CKD group 9135 and 9135. As planned, demographics were similar for people with and without HIV. For example, in the CVD cohort 35% of people with HIV were women, age at entry averaged 41, 23% were "most deprived," and 9% were substance users. While 37% of participants were white, 23% were black, and 36% had missing ethnicity data,
Age at CVD diagnosis averaged 54.5 with HIV versus 56.8 without HIV, a significant difference (adjusted P = 0.002), Age at hypertension diagnosis averaged 49.7 with HIV versus 51.4 without HIV, also a significant difference (adjusted P = 0.002). Age at diagnosis did not differ significantly between the HIV group and the HIV-negative group for diabetes (53.4 vs 52.6, adjusted P = 0.368) or CKD (57.6 vs 58.1, adjusted P = 0.483).
Premature aging indicated by earlier CVD and hypertension in the HIV group must be driven by "underlying mechanisms of HIV infection," antiretroviral therapy, or both, the researchers proposed, because close matching of the HIV+ and HIV- groups lowers chances that demographics, socioeconomic factors, or behaviors account for earlier age at diagnosis with HIV. HIV-related mechanisms contributing to premature aging could include persistent immune activation, chronic inflammation, and T-cell imbalances. Why such mechanisms or antiretroviral therapy would not also drive earlier emergence of diabetes or CKD remains unclear.
The investigators proposed that alleviating premature aging in people with HIV should be a research priority.
References
1. Gooden TE, Wang J, Zemedikum DT, et al. A propensity-score matched cohort study investigating the impact of HIV infection on the ageing process. AIDS 2022, July 29-August 2, Montreal. Abstract EPC130.
2. Gooden TE, Gardner M, Wang J, et al. Incidence of cardiometabolic diseases in people living with and without HIV in the UK: a population-based matched cohort study. J Infect Dis. 2022;225:1348-1356. doi: 10.1093/infdis/jiab420. https://academic.oup.com/jid/article/225/8/1348/6356062
3. Calcagno A, Nozza S, Muss C, et al. Ageing with HIV: a multidisciplinary review. Infection. 2015;43:509-522. doi: 10.1007/s15010-015-0795-5. https://link.springer.com/article/10.1007/s15010-015-0795-5
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