Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

Abstract

ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

Different profiles among older adults with HIV according to their chronological age and the year of HIV diagnosis: The FUNCFRAIL cohort study (GeSIDA 9817)

“…We found higher rates of not only comorbidities among LTHS, but also particular diseases: COPD, history of cancer, osteoarthritis, depression, and other psychiatric disorders. COPD is strongly linked to smoking and more prevalent among people with HIV than in general population [ 20 ]; it consumes a great deal of resources, and has been demonstrated to negatively impact the QOL of people with HIV [ 21 ]. COPD was twice as prevalent within LTHS as in the HAART-era group, and LTHS were more likely to be active smokers.…”

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“…Second, more than 50% of PLWH in Oregon and the United States are over age 50 [3]. Third, PLWH are more likely to experience comorbid medical conditions and experience them at a younger age compared to those without HIV [4]. Fourth, PLWH are more likely to experience social and economic disadvantage than those without HIV [5] and this disadvantage is associated with a greater risk of COVID-19 [6].…”

Bladder cancer in patients with HIV infection: a retrospective study of 14 cases

“…In striking contrast, in this study the median age was 50.5 years, signi cantly lower than the studies previously described, and raised considerable probability that the young age of onset could relate directly to HIV infection. Notably, a Canadian study showed [11] that the median age of HIV infected patients was 40 years old.…”