Changing comorbidities in HIV positive people older than 60 at London clinic

A retrospective review comparing the changing practice at a large London clinic between 2010 and 2017, highlighted the changing needs and concerns for older people living with HIV.

In 2010, approximately 5% of the cohort at Guys and St Thomas in London (126/2700) were older than 60 and by 2017 this increased to 9% in (300/3299) – nearly doubling over seven years. The results were presented in a poster at AIDS 2018, by Ming Lee and colleagues.

Of the people included in 2010, two-thirds (67%) were still in care; with seven lost to follow up (5%), 13 transferred care (10%) and 21 who had died (16.7%). Causes of death include malignancy (8), HIV-related complications (3), sepsis (2), motor neurone disease (1) or was not available (7).

There were no differences between the timepoints in terms of median age or CD4 count, or in demographics like race, gender or sexuality. ART use had increased with >99% patients (299/300) on ARVs in 2017 compared to 94% (119/126) in 2010.

Prevalence of comorbidities had changed significantly however for people >60, with chronic kidney disease (CKD) affecting 30% of the cohort in 2017 compared to 15% in 2010 (p=0.001) and osteopenia/osteoporosis affecting 36% in 2017 compared to 21% in 2010 (p=0.002). More than half the cohorts at each time had hypercholesterolaemia. In 2017, 44% had hypertension, 16% had a history of malignancy and 4% had heart failure (defined as <55% left ventricular fraction). In 2017, 30% had more than three comorbidites compared to 22% in 2010, though this increase was not statistically significant (p=0.07).

Further information on CKD included greater median time on tenofovir DF (median 65 vs 80 months overall, p=0.035) with a trend linking CKD to TDF, after adjusting for age, ethnicity, diabetes and hypertension (p=0.08).

Older age was associated with use of >5 drugs for comorbidities (29%) with at least one potential drug-drug interactions in half of these patients.

The study concluded that part of the increases in fatty liver disease, renal dysfunction, and osteopenia/osteoporosis might reflect improved monitoring in line with updated national guidelines. However, the high rates of multiple comorbidities, polypharmacy and drug interactions required regular ARV reviews for this older population.

Reference
Lee MJ et al. Beyond the 60s: Changing co-morbidities in people living with HIV aged over 60 attending clinic in 2010 and 2017. AIDS 2018, 23-27 July 2018, Amsterdam. Poster abstract TUPEB136.
http://programme.aids2018.org/Abstract/Abstract/3843 (abstract and poster)

Comorbidities	2010 (n=126)		2017 (n=300)		p-value
Ischaemic heart disease	22	17.5%	28	9.3%	0.021
Chronic kidney disease stage 3 or worse (CKD3+)	20	15.9%	91	30.3%	0.001
Osteopenia/osteoporosis	27	21.4%	110	36.7%	0.002
Hypercholesterolaemia	65	51.6%	171	57.0%	0.336
Diabetes Melitus (Type 1 or 2)	14	11.1%	42	14.0%	0.529
Hypertension	–	–	132	44.0%	–
Heart Failure (Left ventricular ejection fraction <55%)	–	–	12	4.0%	–
Malignancy	–	–	50	16.7%	–
>3 of above co-morbidities	28	22.2%	92	30.7%	0.077