Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

Marcus, Julia L.; Leyden, Wendy A.; Alexeeff, Stacey; Anderson, Alexandra; Hechter, Rulin C.; Hu, Haihong; Lam, Jennifer O; Towner, William; Yuan, Qing; Horberg, Michael A.; Silverberg, Michael J.

doi:10.1001/jamanetworkopen.2020.7954

Cited by 406 publications

(319 citation statements)

References 26 publications

Supporting

Mentioning

313

Contrasting

Unclassified

Order By: Relevance

“…For PWH without private insurance, the RWHAP should consider increasing its support for and coverage of preventative non-HIV care to help bridge the gap in access. An investment in preventative care could help reduce the gap in comorbidity-free years between PWH and people without HIV [ 1 ]. This would improve the quality of life of PWH and have positive economic ramifications by decreasing Medicare expenditures for PWH who are over the age of 65.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic

Arant

Harding

Geba

et al. 2020

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Age-related chronic conditions are becoming more concerning for people with human immunodeficiency virus (PWH). We aimed to identify characteristics associated with multimorbidity and evaluate for association between multimorbidity and human immunodeficiency virus (HIV) outcomes. Methods Cohorts included PWH aged 45–89 with ≥1 medical visit at one Ryan White HIV/AIDS Program (RWHAP) Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2). Multimorbidity was defined as ≥2 chronic diseases. We used multivariable logistic regression to assess for associations between characteristics and multimorbidity and between multimorbidity and HIV outcomes. Results Multimorbidity increased from Cohort 1 (n = 149) to Cohort 2 (n = 323) (18.8% vs 29.7%, P < .001). Private insurance was associated with less multimorbidity than Medicare (Cohort 1: adjusted odds ratio [aOR] = 0.15, 95% confidence interval [CI] = 0.02–0.63; Cohort 2: aOR = 0.53, 95% CI = 0.27–1.00). In Cohort 2, multimorbidity was associated with female gender (aOR, 2.57; 95% CI, 1.22–5.58). In Cohort 1, black participants were less likely to be engaged in care compared with non-black participants (aOR, 0.72; 95% CI, 0.61–0.87). In Cohort 2, participants with rural residences were more likely to be engaged in care compared with those with urban residences (aOR, 1.23; 95% CI, 1.10–1.38). Multimorbidity was not associated with differences in HIV outcomes. Conclusions Although PWH have access to RWHAP HIV care, PWH with private insurance had lower rates of multimorbidity, which may reflect better access to preventative non-HIV care. In 2016, multimorbidity was higher for women. The RWHAP and RWHAP Part D could invest in addressing these disparities related to insurance and gender.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The life expectancy of people with human immunodeficiency virus (PWH) is approaching that of those without human immunodeficiency virus (HIV), largely due to effective antiretroviral therapy (ART) [ 1 ]. In 2015, approximately half of PWH in the United States were estimated to be over age 50 [ 2 ].…”

mentioning

confidence: 99%

Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic

Arant

Harding

Geba

et al. 2020

Open Forum Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Los avances en el tratamiento del VIH han permitido disminuir de forma importante la mortalidad asociada al SIDA; sin embargo, la presencia de inflamación crónica y activación inmunológica persistente se han relacionado con la aparición de comorbilidades no asociadas al SIDA, entre las que destacan las alteraciones metabólicas, enfermedad cardiovascular, cáncer, osteoporosis y obesidad (4)(5)(6) .…”

Section: Comorbilidades En El Paciente Con Vihunclassified

Implicaciones clínicas e inmunológicas de los micronutrientes durante la infección por VIH

Padilla¹,

Moguel

Vargas

et al. 2020

Rev. Nutr. Clin. Metab.

View full text Add to dashboard Cite

“…There is a persistent life expectancy gap of 8–9 years between people living with HIV (PLWH) and the general population [ 1 , 2 ]. Reasons may include an increased risk for atherosclerotic cardiovascular disease (ASCVD) [ 3 , 4 ], non-AIDS defining cancers [ 5 ], osteoporosis, and accelerated liver fibrosis [ 6 ] which have been summarized as HIV-associated non-AIDS comorbidity and carry, along with non-AIDS-defining infections, a higher attributable mortality in PLWH [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Consistent use of lipid lowering therapy in HIV infection is associated with low mortality

et al. 2021

View full text Add to dashboard Cite

Background In people living with HIV (PLWH), statins may be disproportionately effective but remain underutilized. A large prospective trial in patients with low to moderate cardiovascular (ASCVD) risk will reveal whether they should be considered in all PLWH. But its effect size may not apply to real-world PLWH with higher ASCVD and mortality risk. Also, the clinical role of non-statin lipid-lowering therapy (LLT) and LLT adherence in this population is unknown. Methods Comparative multi-level marginal structural model for all-cause mortality examining four time-updated exposure levels to LLT, antihypertensives, and aspirin in a virtual cohort of older PLWH. Incident coronary, cerebrovascular, and overall ASCVD events, serious infections, and new cancer diagnoses served as explanatory outcomes. Results In 23,276 HIV-infected US-veterans who were followed for a median of 5.2 years after virologic suppression overall mortality was 33/1000 patient years: > 3 times higher than in the US population. Use of antihypertensives or aspirin was associated with increased mortality. Past LLT use (> 1 year ago) had no effect on mortality. LLT exposure in the past year was associated with a reduced hazard ratio (HR) of death: 0.59, 95% confidence interval (CI) 0.51–0.69, p < 0.0001 for statin containing LLT and 0.71 (CI: 0.54–0.93), p = 0.03 for statin-free LLT. For consistent LLT use (> 11/12 past months) the HR of death was 0.48 (CI: 0.35–0.66) for statin-only LLT, 0.34 (CI: 0.23–0.52) for combination LLT, and 0.27 (CI: 0.15–0.48) for statin-free LLT (p < 0.0001 for all). The ASCVD risk in these patients was reduced in similar fashion. Use of statin containing LLT was also associated with reduced infection and cancer risk. Multiple contrasting subgroup analyses yielded comparable results. Confounding is unlikely to be a major contributor to our findings. Conclusions In PLWH, ongoing LLT use may lead to substantially lower mortality, but consistent long-term adherence may be required to reduce ASCVD risk. Consistent non-statin LLT may be highly effective and should be studied prospectively.

show abstract

Comparison of Overall and Comorbidity-Free Life Expectancy Between Insured Adults With and Without HIV Infection, 2000-2016

Abstract: IMPORTANCE Antiretroviral therapy (ART) has improved life expectancy for individuals with HIV infection, but recent data comparing life span and comorbidity-free years by HIV status are lacking.

Cited by 406 publications

References 26 publications

Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic

Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic

Implicaciones clínicas e inmunológicas de los micronutrientes durante la infección por VIH

Consistent use of lipid lowering therapy in HIV infection is associated with low mortality

Contact Info

Product

Resources

About