| |
Incidence of non-AIDS defining comorbidities among
young adults with perinatally acquired HIV in North America
|
| |
| |
Download the PDF here
July 15 2024
Haw, Nel Jason L.a; Lesko, Catherine R.a; Ng, Derek K.a; Lam, Jenniferb; Lang, Raynellc; Kitahata, Mari M.d; Crane, Heidid; Eron, Joseph Jr.e; Gill, M. Johnc,f; Horberg, Michael A.g; Karris, Maileh; Loutfy, Monai,j; McG
"Our results suggest that by age 30, about one in five people with PHIV have T2DM, two in five have hypercholesterolemia, one in two have hypertriglyceridemia, one in four have hypertension, and one in four have CKD. We also found that about one in five have already developed hypercholesterolemia and hypertriglyceridemia before they transitioned into adult HIV care. Across sex at birth and self-identified race, non-Black women had the highest incidence of hypercholesterolemia and hypertriglyceridemia, Black adults with PHIV had the highest incidence of hypertension, and Black men had the highest incidence of CKD."
we found a high incidence of five NADCs among a young adult population with PHIV in the age of ART. Timely treatment of these NADCs may mitigate downstream consequences, thus future clinical guidelines may consider lowering the age at which screening for these conditions is recommended for people with PHIV. We recommend clinicians who care for young adults with PHIV in adult care to consider their history of dyslipidemia during pediatric care, and consider screening for T2DM, dyslipidemia, hypertension, and CKD.
There were 375 people aged 18–30 years with PHIV between 2000 and 2019 from 14 participating NA-ACCORD cohorts. The median year of enrollment was 2012 [interquartile range (IQR): 2010, 2015], median age of enrollment was 22 years (IQR: 19, 25), and median follow-up time was 3.0 years (IQR: 1.1, 5.5).
At study entry, 39% had undetectable viral load and median CD4+ cell count was 412 cells/μl (IQR: 176, 675). At study entry, 54% were on protease inhibitor-containing therapies, while 39% were on integrase inhibitor-containing therapies. At study entry, 27% were ever smokers, and the median BMI was 23.6 (IQR: 20.7, 28.1). The numbers of prevalent cases at study entry of the NADCs under study were 5 (1%) for T2DM, 62 (18%) for hypercholesterolemia, 74 (21%) for hypertriglyceridemia, 19 (5%) for hypertension, and 9 (2%) for CKD.
Abstract
Objective:
The aim of this study is to describe the incidence of diabetes mellitus type 2 (T2DM), hypercholesterolemia, hypertriglyceridemia, hypertension, and chronic kidney disease (CKD) from 2000 to 2019 among North American adults with perinatally acquired HIV (PHIV) aged 18–30 years.
Design:
Description of outcomes based on electronic health records for a cohort of 375 young adults with PHIV enrolled in routine HIV care at clinics contributing data to the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).
Methods:
We estimated overall, sex, and race-stratified cumulative incidences using Turnbull estimation, and incidence rates using quasi-Poisson regression. T2DM was defined as glycosylated hemoglobin more than 6.5% or based on clinical diagnosis and medication use. Hypercholesterolemia was based on medication use or total cholesterol at least 200 mg/dl. Hypertriglyceridemia was based on medication use or fasting triglyceride at least 150 mg/dl or nonfasting at least 200 mg/dl. Hypertension was based on clinical diagnosis. CKD was defined as estimated glomerular filtration rates less than 90 ml/mi|1.73 m2 for at least 3 months.
Results:
Cumulative incidence by age 30 and incidence rates from age 18 to 30 (per 100 person-years) were T2DM: 19%, 2.9; hypercholesterolemia: 40%, 4.6; hypertriglyceridemia: 50%, 5.6; hypertension: 22%, 2.0; and CKD: 25%, 3.3. Non-Black women had the highest incidence of hypercholesterolemia and hypertriglyceridemia, Black adults had the highest hypertension incidence, and Black men had the highest CKD incidence.
Conclusion:
There was a high incidence of five chronic comorbidities among people with PHIV. Earlier screening at younger ages might be considered for this unique population to strengthen prevention strategies and initiate treatment in a timely way.
|
|
| |
| |
|
|
|
