The projected prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030

Abstract

Importance: Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. Objective: To project the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the US through 2030. Design: Agent-based simulation model Setting: HIV clinics in the United States in the recent past (2020) and near future (2030) Participants: In 2020, 674,531 PWH were using ART; 9% were men and 4% women with history of injection drug use; 60% were men who have sex with men (MSM); 8% were heterosexual men and 19% heterosexual women; 44% were non-Hispanic Black/African American (Black); 32% were non-Hispanic White (White); and 23% were Hispanic. Exposure(s): Demographic and HIV acquisition risk subgroups Main Outcomes and Measures: Projected prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV). Results: We projected 914,738 PWH using ART in the US in 2030. Multimorbidity increased from 58.3% in 2020 to 63.4% in 2030. The prevalence of depression and/or anxiety was high and increased from 60.1% in 2020 to 64.5% in 2030. Hypertension and dyslipidemia decreased, diabetes and CKD increased, MI increased steeply, but there was little change in cancer and ESLD. Among Black women with history of injection drug use (oldest demographic subgroup in 2030), CKD, anxiety, hypertension, and depression were most prevalent and 93.4% were multimorbid. Among Black MSM (youngest demographic subgroup in 2030), depression was highly prevalent, followed by hypertension and 482% were multimorbid. Comparatively, 67.1% of White MSM were multimorbid in 2030 (median age in 2030=59 years) and anxiety, depression, dyslipidemia, CKD, and hypertension were highly prevalent. Conclusion and relevance: The distribution of multimorbidity will continue to differ by race/ethnicity, gender, and HIV acquisition risk subgroups, and be influenced by age and risk factor distributions that reflect the impact of social disparities of the health on women, people of color, and people who use drugs. HIV clinical care models and funding are urgently required to meet the healthcare needs of people with HIV in the next decade.

Cardiac and Renal Comorbidities in Aging People Living With HIV

“…Data from the United States predicts that by 2030, nearly 50% of PLWH will have multiple comorbidities, with significant increases in CKD, dyslipidemia, diabetes, and myocardial infarction. 14 In South Africa, PLWH over 50 years of age have a 2-fold increased risk of having multiple comorbidities, including diabetes and hypertension. 15 Among 450 PLWH from Tanzania, age was the only independent predictor of diminishing renal function.…”

Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya

“…These PWH are at greater risk for many ageassociated comorbidities, including cardiovascular, metabolic, pulmonary, and renal conditions; as well as non-AIDS-defining cancers [4][5][6][7][8][9][10][11][12]. Such multimorbidity leads to increasingly complex care management and increased likelihood of polypharmacy, or the simultaneous use of multiple medications [13,14]. Although research on age-related comorbidities and the age distribution of PWH is gaining traction, studies often focus on high-income settings [15][16][17].…”