Earlier and greater comorbidities reported in HIV positive cohort

A study from Amsterdam reported significantly higher rates of health complications in HIV positive people.

Judith Schouten and colleagues from the Academic Medical Centre in Amsterdam, reported on age-associated non-infectious co-morbidities in 381 HIV positive patients older than 45 years, compared to 349 age, gender and ethnicity matched HIV negative patients seen at a sexual health clinic.

Patients were enrolled consecutively and studied prospectively. Median age was approximately 52 years (IQR 48-60) for both groups. HIV positive people had been positive a median of 12 years (IQR 6-17). Median current and nadir CD4 counts were 573 (IQR 436-748) and 210 (IQR 130-310) cells/mm3, respectively, with 30% having a previous AIDS diagnosis. 91% were on ART (85% with undetectable viral load) for a median of 11 years (IQR 5-15).

HIV positive people were more likely to be current smokers (32% vs 24%) but less likely to be heavy drinkers (3.5% vs 6.9%). Use of recreational drugs was similar (17% used ecstasy, cocaine or cannabis in the prior month). BMI and systolic BP were similar but diastolic BP was slightly higher for the positive group (median 82 vs 79 mmHg, p<0.001).

The rates of comorbidities increased with age in both groups. However, HIV positive patients consistently reported a higher incidence of one or more comorbiditiy (75% vs 62%) and a higher mean number of co-morbidities (0.87-2.03 vs 0.69-1.73), see Table 1. BMI, use of recreational drugs and alcohol, ethnicity and sexual orientation (MSM) were not found to be independent risk factors.

After adjusting for age, gender and pack years of smoking, HIV positive patients were significantly more likely per five years to have more comorbidities (OR 1.24 per; 95%CI 1.07-1.27, p=0.0003). In the HIV positive group, duration of ART use (OR 1.24; 95%CI 1.06-1.46, p=0.009) and lower nadir CD4 count per 100 less cells (OR 1.12; 95%CI 0.99-1.28, p=0.074), but not duration of infection, were each associated with an increased risk of more complications.

Hypertension, angina pectoris, myocardial infarction, peripheral arterial insufficiency, cerebrovascular disease, cancer and chronic liver disease were all significantly more prevalent in the HIV positive group.

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Table 1: Incidence and mean number of non-infectious comorbidities
	HIV positive	HIV negative	p
>/=1 comorbididity	74.5%	61.6%	<0.001
age 45-50	59.8%	49.6%	<0.0001 for trend
age 65+	94/5%	8.5%	<0.0001 for trend
Mean number of comorbidities
age 45-50	0.87	0.69
age 65+	2.03	1.73

However, an appropriate control group is always difficult for HIV studies as HIV positive people are likely to receive a higher level of monitoring and more careful follow-up than age-matched adult attending GUM services.

Even if this study is picking up earlier diagnosis of comorbid conditions than the control group and this is a marker of closer monitoring and care, it still leaves these patients with a higher level of treated conditions and more complex polypharmacy.

Schouten J et al. Comorbidity and ageing in HIV-1 infection: the AGEhIV Cohort Study. 14th IWCADR, 19-21 July 2012, Washington. Oral abstract 024. Antiviral therapy 2012; 17 Suppl 2:A20.