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High Comorbidity Rates PWH > 61: kidney/CVD/HTN/Lipids/cancer/bones/Psych-Depression
Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care
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Overall, the most common comorbidities were psychiatric disorders (54.2%), dyslipidemia (46.0%), hypertension (40.4%), and chronic kidney disease (26.0%).
The mean number of comorbidities increased with advancing age, with 1.4 (95% CI 1.19-1.56) observed among persons in the 18-40-year age group, compared to other age groups which averaged 2.1, 3.0, and 3.9 comorbidities, respectively (P < 0.001 for trend; Fig 1.
The prevalence of each comorbidity significantly increased with advancing age, except for hepatitis B virus infection and psychiatric disorders (Fig. 2 appendix.
In univariate analyses, we found that older age, female sex, and NHB race/ethnicity were each positively and significantly associated with having a greater number of comorbidities (Table 2). ........We observed greater mean numbers of comorbidities among heterosexuals and PWID (compared with MSM), persons with public insurance or self-pay/no insurance (compared with persons with private insurance), those who were obese (compared with those having normal BMI). Univariate analyses of the associations between demographic, behavioural, and clinical factors with specific comorbidities are shown in Supplemental Table 2.
In multivariable analyses (Table 2), factors significantly associated with having a greater number of NACMs included older age, having a history of injection drug use (IDU), BMI at least 25.0, having public insurance, and earlier calendar period (2002-2006).
We evaluated 11 NACMs: cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, HBV or HCV infection, chronic kidney disease, chronic anemia, psychiatric illness, and chronic joint disease/fracture.
PWH >60 had on average 4 comorbidities, increasing from younger ages: By age strata 18-40, 41-50, 51-60, and at least 61 years, there were 180, 502, 560, and 298 patients, respectively. Median HIV Outpatient Study observation was 10.8 years (range: min-max = 5.0-18.5). Mean number of NACMs increased with older age category (1.4, 2.1, 3.0, and 3.9, respectively; P < 0.001), as did prevalence of most NACMs (P < 0.001).
Conclusions: Age-related increases existed in prevalence and number of NACMs, with disproportionate burden among women, NHBs, and the publicly insured. These groups should be targeted for screening and prevention strategies aimed at NACM reduction. Our findings highlight the need for clinicians to consider demographic, healthcare coverage, and social determinants of health in the routine primary care of persons with HIV; such factors may ultimately inform healthcare delivery systems, including interventions aimed at screening for and preempting of important age-related NACMs.
This phenomenon may be related to at least two issues: persons living with HIV more frequently have risk factors for many NACMs, such as tobacco smoking, dyslipidemia, insulin resistance, chronic hepatitis C virus (HCV) or hepatitis B virus (HBV) infection, recreational substance use, obesity, poverty, and mental illness [6-16]; HIV infection, even among ART-treated and virologically suppressed persons, is associated with chronically elevated levels of systemic inflammation, immune dysregulation, and hypercoagulability [17-20]. Indeed, existing data suggest that current routine, well health screening strategies developed in the general population, such as for cardiovascular disease or bone fracture risk, may be inadequate for persons living with HIV [21,22].
PWH > 61 yrs old had highest percentage of comorbidities:
PWH over 61 yrs old: 60%+ hypertension: 60% hyperlipidemia; 55% psychiatric including depression; 45% chronic kidney disease; 58% cardiovascular; 18% cancers; 23% chronic HCV; 10% anemia. Cancer rtes doubt from 41-50 to >61; Kidney disease rates triple; CVD rates increase 4-fold from 18-40 to >61.
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