{"id":19814,"date":"2012-08-01T12:21:32","date_gmt":"2012-08-01T12:21:32","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=19814"},"modified":"2012-08-17T08:10:37","modified_gmt":"2012-08-17T08:10:37","slug":"earlier-and-greater-comorbidities-reported-in-hiv-positive-cohort","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/19814","title":{"rendered":"Earlier and greater comorbidities reported in HIV positive cohort"},"content":{"rendered":"

Simon Collins, HIV i-Base<\/strong><\/p>\n

A study from Amsterdam reported significantly higher rates of health complications in HIV positive people.<\/strong><\/p>\n

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.<\/p>\n

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).<\/p>\n

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).<\/p>\n

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.<\/p>\n

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.<\/p>\n

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.<\/p>\n\n\n\n\n\n\n\n\n\n
Table 1: Incidence and mean number of non-infectious comorbidities<\/caption>\n
<\/td>\nHIV positive<\/th>\nHIV negative<\/th>\np<\/th>\n<\/tr>\n
>\/=1 comorbididity<\/th>\n74.5%<\/td>\n61.6%<\/td>\n<0.001<\/td>\n<\/tr>\n
age 45-50<\/th>\n59.8%<\/td>\n49.6%<\/td>\n<0.0001 for trend<\/td>\n<\/tr>\n
age 65+<\/th>\n94\/5%<\/td>\n8.5%<\/td>\n<0.0001 for trend<\/td>\n<\/tr>\n
Mean number of comorbidities<\/th>\n<\/tr>\n
age 45-50<\/th>\n0.87<\/td>\n0.69<\/td>\n<\/tr>\n
age 65+<\/th>\n2.03<\/td>\n1.73<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

comment<\/h2>\n

These results are important and have been highlighted by other groups.<\/strong><\/p>\n

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.<\/strong><\/p>\n

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.<\/strong><\/p>\n

References:<\/p>\n

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.<\/p>\n

This study was also presented at the 19th IAS Conference. Abstract THAB0205.<\/p>\n

http:\/\/pag.aids2012.org\/abstracts.aspx?aid=14739<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Simon Collins, HIV i-Base 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 …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,8],"tags":[160],"class_list":["post-19814","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-side-effects","tag-lipo-14th-2012"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/19814","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=19814"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/19814\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=19814"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=19814"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=19814"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}