{"id":34809,"date":"2018-08-24T11:44:59","date_gmt":"2018-08-24T11:44:59","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=34809"},"modified":"2018-08-24T15:43:26","modified_gmt":"2018-08-24T15:43:26","slug":"changing-comorbidies-in-hiv-positive-people-older-than-60-at-london-clinic","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/34809","title":{"rendered":"Changing comorbidities in HIV positive people older than 60 at London clinic"},"content":{"rendered":"

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

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

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.\u00a0The results were presented in a poster at AIDS 2018, by Ming Lee and colleagues.<\/p>\n

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).<\/p>\n

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.<\/p>\n

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).<\/p>\n

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).<\/p>\n

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.<\/p>\n

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.\u00a0However, the high rates of multiple comorbidities, polypharmacy and drug interactions required regular ARV reviews for this older population.<\/p>\n

Table 1: Prevalence of comorbidities in 2010 and 2017<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
Comorbidities<\/td>\n2010 (n=126)<\/td>\n2017 (n=300)<\/td>\np-value<\/td>\n<\/tr>\n
Ischaemic heart disease<\/td>\n22<\/td>\n17.5%<\/td>\n28<\/td>\n9.3%<\/td>\n0.021<\/td>\n<\/tr>\n
Chronic kidney disease stage 3 or worse (CKD3+)<\/td>\n20<\/td>\n15.9%<\/td>\n91<\/td>\n30.3%<\/td>\n0.001<\/td>\n<\/tr>\n
Osteopenia\/osteoporosis<\/td>\n27<\/td>\n21.4%<\/td>\n110<\/td>\n36.7%<\/td>\n0.002<\/td>\n<\/tr>\n
Hypercholesterolaemia<\/td>\n65<\/td>\n51.6%<\/td>\n171<\/td>\n57.0%<\/td>\n0.336<\/td>\n<\/tr>\n
Diabetes Melitus (Type 1 or 2)<\/td>\n14<\/td>\n11.1%<\/td>\n42<\/td>\n14.0%<\/td>\n0.529<\/td>\n<\/tr>\n
Hypertension<\/td>\n–<\/td>\n–<\/td>\n132<\/td>\n44.0%<\/td>\n–<\/td>\n<\/tr>\n
Heart Failure (Left ventricular ejection fraction <55%)<\/td>\n–<\/td>\n–<\/td>\n12<\/td>\n4.0%<\/td>\n–<\/td>\n<\/tr>\n
Malignancy<\/td>\n–<\/td>\n–<\/td>\n50<\/td>\n16.7%<\/td>\n–<\/td>\n<\/tr>\n
>3 of above co-morbidities<\/td>\n28<\/td>\n22.2%<\/td>\n92<\/td>\n30.7%<\/td>\n0.077<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Reference
\nLee 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.
\nhttp:\/\/programme.aids2018.org\/Abstract\/Abstract\/3843<\/a> (abstract and poster)<\/p>\n","protected":false},"excerpt":{"rendered":"

Simon Collins, HIV i-Base 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 …<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,31],"tags":[255],"class_list":["post-34809","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-opportunistic-infections-coinfections-and-complications","tag-world-aids-22-amsterdam-2018"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/34809","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\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=34809"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/34809\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=34809"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=34809"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=34809"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}