Higher Rates of Five Major Non-AIDS Comorbidities After Age 50
August 8, 2016
Among eight serious non-AIDS comorbidities studied in a large Spanish HIV cohort, five developed more frequently in people 50 and older, including non-AIDS cancer and cardiovascular, kidney, bone and metabolic disease. Non-AIDS cancer developed in almost 14 of every 1000 older cohort members every year in this 2004-2014 analysis. Cardiovascular disease was diagnosed in people 50 and older six times more often than in younger people, according to the study, which was presented at AIDS 2016.
As antiretroviral therapy promotes longer survival of HIV-positive people, age-related illnesses account for growing shares of morbidity and mortality. Spanish researchers working with the multicenter, longitudinal CoRIS cohort described patterns of non-HIV morbidity according to age from 2004 to 2014. HIV-positive people seeking care at a participating center may enter CoRIS if they are older than 13 years and naive to antiretroviral therapy upon entry. The CoRIS team used medical records to determine the age distribution of cohort members from 2004 through 2014 and to calculate incidence per 1000 person-years for eight comorbidities: cardiovascular disease, kidney-associated events, liver-associated events, bone disease, psychiatric illness, metabolic illness, non-AIDS infections and non-AIDS malignancies.
The analysis involved 9,569 CoRIS members with 34,105 person-years of follow-up. Most participants, 84%, were men and 58% were men who have sex with men. At entry to the cohort, median CD4 count stood at 350 cells/mm3 (interquartile range [IQR] 170 to 552). CoRIS is a young cohort, with a median cohort entry age of 35 years (IQR 29 to 43). The proportion of total person-years at age 50 and older rose from 8.8% in 2004 to 21.2% in 2014.
Read: Really Rapid Review -- AIDS 2016, Durban
Among people 50 or older, one comorbidity developed during 17% of total person-years, and two or more comorbidities developed during 4% of total person-years. For younger cohort members, respective rates were 8% for one comorbidity and 1% for two or more. Psychiatric illnesses were the most frequent comorbidity overall, at an incidence of 6.30 per 1000 person-years, followed by non-AIDS malignancies (5.32 per 1000), bone disease (3.58 per 1000), liver disease (2.76 per 1000), kidney disease (2.61 per 1000), metabolic disease (2.55 per 1000), cardiovascular disease (2.49 per 1000) and non-AIDS infections (0.32 per 1000).
Five comorbidities had significantly higher incidence in people 50 and older than in younger cohort members, led by non-AIDS malignancies (13.61 versus 5.16 per 1000 person-years, P < .001), and followed by cardiovascular disease (8.75 versus 1.38 per 1000, P < .001), metabolic disease (7.40 versus 1.69 per 1000, P < .001), bone disease (5.81 versus 3.19 per 1000, P = .004) and kidney disease (5.60 versus 2.07 per 1000, P < .001). Incidence rates of liver disease (3.46 versus 2.63 per 1000) and non-AIDS infections (0.57 versus 0.27 per 1000) were nonsignificantly higher in older cohort members. Incidence of psychiatric illness was almost identical in older and younger cohort members (6.28 and 6.30 per 1000).
For the five comorbidities with significantly higher incidence in people 50 and older, the difference in incidence between the older and younger groups was highest for cardiovascular disease (6.34-fold higher), followed by metabolic disease (4.38-fold higher), kidney disease (2.71-fold higher), non-AIDS malignancy (2.64-fold higher) and bone disease (1.82-fold higher).
Mark Mascolini writes about HIV infection.
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