May 4, 2017
HIV-positive people 65 years old or older have higher rates of common non-AIDS diseases like heart disease and diabetes than HIV-negative people that age.1 The findings come from analysis of almost 30 million U.S. residents who use Medicare, the government health insurance plan for people 65 or older.
Much research shows that people with HIV have higher rates of age-related non-AIDS diseases than people without HIV. These diseases include cardiovascular disease, bone disease, diabetes, and kidney disease. Some of this research on non-AIDS disease frequency involves HIV-positive people 50 or older, but there has been little research on HIV-positive people 65 or olderthe age when most people in the United States start using Medicare. Research suggests that the average age of people treated for HIV in the United States will jump from 49 in 2015 to 58 in 2035,2 so the U.S. HIV population will include a growing proportion of people 65 and older.
To get a better understanding of how age-related non-AIDS conditions are affecting elderly U.S. HIV patients today, researchers from the Association of Schools and Programs of Public Health (ASPPH) and the Centers for Disease Control and Prevention (CDC) conducted this study.
Researchers identified Medicare users (all of whom must be 65 or older) by reviewing Medicare parts A and B claims for at least 11 continuous months in the years 2006 through 2009. (Part A is hospital insurance; part B is medical insurance.) The analysis did not include people using Medicare within a Health Maintenance Organization. The investigators identified Medicare patients with HIV by using medical codes indicating HIV infection in one hospital or nursing facility Medicare claim or two outpatient (nonhospital) claims.
The researchers also used medical codes to determine which Medicare patients with or without HIV had one or more of the five most common chronic health conditions: hypertension (high blood pressure), high lipids (cholesterol and triglycerides), ischemic heart disease, diabetes, and rheumatoid arthritis or osteoarthritis. Then the research team used standard statistical methods to compare chances of having one of these conditions in people with versus without HIV. This type of analysis accounts for the impact of other factors that raise the risk of these conditionsolder age, male versus female sex, race or ethnicity, end-stage kidney disease, and use of both Medicare and Medicaid (which indicates lower income). Thus the analysis figures the impact of HIV on chances of these conditions regardless of whatever other risk factors a person has.
The analysis included 29,060,418 Medicare users age 65 or older. There were 24,735 people with HIV, about one-tenth of 1% of the whole group. As a group, HIV-positive Medicare users were about 4 years younger than the HIV-negative group. Compared with the HIV-negative group, Medicare users with HIV were almost twice as likely to be men and 5 times as likely to be African American or Hispanic. The HIV group was about 3 times more likely than the non-HIV group to use Medicaid as well as Medicareindicating lower income in the HIV group.
Compared with HIV-negative Medicare users, HIV-positive Medicare patients were twice as likely to have hypertension or arthritis, 80% more likely to have high lipids or heart disease, and 50% more likely to have diabetes (Figure 1). These higher chances of the five conditions with HIV held true regardless of other major risk factors for these conditions.
Figure 1. People 65 or older had higher risks of five common conditions if they had HIV in a 30-million-person nationwide U.S. study. (Credit: Teresa B. Southwell)
In a separate analysis that also considered the impact of several illness risk factors, Medicare users with HIV were more than twice as likely to have 1 or 2 of the five conditions studied than people without HIV (Figure 2). The HIV group was 3 as likely as the HIV-negative group to have 3 of the conditions studied, 4 times as likely to have 4 of those conditions, and 7 times as likely to have all 5 of those conditions (Figure 2). This analysis considered the potential impact of factors that raise the risk of chronic conditionsolder age, male versus female sex, race or ethnicity, end-stage kidney disease, and use of both Medicare and Medicaid (which indicate lower income and long-term disabled status).
Figure 2. Compared with HIV-negative people 65 or older, HIV-positive people that age ran a higher risk of having 1, 2, 3, 4, or 5 conditions studied: hypertension, arthritis, high lipids, heart disease, and diabetes. (Credit: Teresa B. Southwell)
If an HIV-positive person had additional risk factors, it was even more likely that this person would have 1 or more chronic conditions. For instance (1) men were more likely than women, (2) African Americans and Hispanics were more likely than whites, (3) people with both Medicare and Medicaid (indicating lower income) were more likely than people only with Medicare, and (4) people with end-stage kidney disease were more likely than those without end-stage kidney disease. Two groups were less likely to have 1 or more of the studied conditions: (1) younger people were less likely than older people, and (2) HIV-positive Asian/Pacific Islanders and Native Americans were less likely than whites.
This very large study of Medicare users (all 65 or older) across the United States found that older people with HIV were more likely than those without HIV to have all five age-related conditions studied: hypertension (high blood pressure), high cholesterol or triglycerides, ischemic heart disease, diabetes, and arthritis. Compared with HIV-negative Medicare users, HIV-positive Medicare users were more likely to have 1, 2, 3, 4, or all 5 of these conditions.
This study adds to the convincing evidence that people with HIV face greater threats to their health as they age than people without HIV. Most previous studies of aging and HIV were much smaller and used age 50 as the cutoff between middle age and old age. This new study is valuable because it is much larger than previous studies, includes people across the United States, and uses 65 as the middle-to-old-age cutoff.
Because so many HIV-positive people in the United States are taking effective antiretroviral therapy (see "Viral Loads Becoming Undetectable in More People Across the United States" in this issue3), they are living well into their 60s and 70s. Even without HIV, they would face an increasing risk of age-related disease as they grew older. This study addresses the question whether HIV-positive people 65 or older face a greater risk of these diseases than people the same age without HIV. The answer is yes.
Many age-related conditions can be prevented or effectively treated if they do develop. Maintaining an active lifestyle and eating a balanced diet can prevent or slow development of many age-related conditions. And preventing or treating one condition can often prevent others. For example, among the conditions in this analysis, preventing or treating hypertension (high blood pressure), high cholesterol, or diabetes can prevent heart disease. High blood pressure, high cholesterol, and diabetes can all be detected with simple tests. It is important to work with your HIV provider to get regular testing for conditions like these, to develop prevention plans, and to get treated for conditions that do arise.
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