Aging with HIV vs. HIV Seroconversion at Older Age: A Diverse Population with Distinct Comorbidity Profiles

Abstract

ObjectivePeople aging with HIV might have different health conditions compared with people who seroconverted at older ages. The study objective was to assess the prevalence of, and risk factors for, individual co-morbidities and multimorbidity (MM) between HIV-positive patients with a longer duration of HIV infection, and patients who seroconverted at an older age. We compared estimates across both groups to a matched community-based cohort sampled from the general population.MethodsWe performed a case-control study including antiretroviral therapy (ART)–experienced patients who were HIV seropositive for ≥ 20.6 years (“HIV-Aging”), or who were seropositive for < 11.3 years (“HIV-Aged”) having access in 2013 at the Modena HIV Metabolic Clinic. Patients were matched in a 1:3 ratio with controls from the CINECA ARNO database. MM was defined as the concurrent presence of >2 NICM. Logistic regression models were constructed to evaluate associated predictors of NICM and MM.ResultsWe analysed 404 HIV-Aging and 404 HIV-Aged participants in comparison to 2424 controls. The mean age was 46.7±6.2 years, 28.9% were women. Prevalence of HIV co-morbidities and MM were significantly higher in the HIV-positive groups compared to the general population (p<0.001) and a trend towards higher rates of MM was found in aging vs aged group. This difference turned to be significant in patients above the age of 45 years old (p<0.001).ConclusionsPeople aging with HIV display heterogeneous health conditions. Host factors and duration of HIV infection are associated with increased risk of MM compared to the general population.

Immunosenescence and hurdles in the clinical management of older HIV-patients

“…3 The incidence of infectious and non-infectious comorbidities and overall mortality have been found to be higher in HIV infected patients compared with HIV-negative ones. 4 Moreover the duration of HIV infection seems to be a stronger predictor of morbidity and non-infectious comorbidities compared with age at the diagnosis. 4 The main problems with older people are the low perception of risk and the stigma of speaking about sex, even with people sexually active.…”

“…4 Moreover the duration of HIV infection seems to be a stronger predictor of morbidity and non-infectious comorbidities compared with age at the diagnosis. 4 The main problems with older people are the low perception of risk and the stigma of speaking about sex, even with people sexually active. These 2 factors make more difficult to achieve HIV diagnosis and consequently they cause a delay that can lead to a severe immune deficiency.…”

HIV diagnosis increasing in older adults in Europe

“…This has implications for their long-term health and well-being, particularly if they present when their HIVinfection is advanced 10 . In Europe and North America, increased mortality among older people living with HIV is often attributed to increased prevalence of illnesses such as cardiovascular disease, and kidney and liver failure, which may worsen HIV disease progression 11 . These older people are also at greater risk of infectious diseases, such as tuberculosis 12 Providing easy access to testing, is a first step in getting people living with HIV on to treatment.…”

New HIV Diagnoses among Older Adults in the EU/EEA: Missed Opportunities and Barriers to Testing

“…However, it has been shown that aging PLHIV are subject to an increased level of multimorbidity as compared to the general population, encompassing increased risk of various conditions such as cardiovascular diseases, osteoporosis, chronic obstructive pulmonary disease (COPD), hypertension, types 2 diabetes mellitus and non-AIDS defining cancers [5][6][7]. While people with longer duration of HIV infection show an increased risk for multimorbidity as compared to people that acquire the infection at older age [8], older adults infected with HIV are at increased risk of short-term mortality, particularly if diagnosed at an advanced stage of the disease [9,10].…”