Adult women living with HIV experience more non-AIDS comorbidities than HIV-negative women, with the most pronounced differences in comorbidity burden occurring at the youngest ages, a U.S. study published in Clinical Infectious Diseases found.
Data on 3,129 participants in the Women’s Interagency HIV Study, 890 of whom were HIV-negative, found that non-AIDS comorbidities began occurring in significant numbers among women in their 20s regardless of HIV status, with greater blood pressure increases noted in particular. However, high blood pressure and other risk factors arose earlier in the lives of WLWH than in HIV-negative women.
Overall, non-AIDS comorbidity incidence was 48% higher among WLWH under the age of 25 than their HIV-negative counterparts (after adjusting for demographic factors such as race, drug/alcohol use, body mass index, and income level). By comparison, incidence was 36% higher among WLWH age 55 or over, and ranged widely from 1% (among 40- to 44-year-olds) to 31% (among 25- to 29-year-olds) within a stratified set of five-year age groups between 25 and 55.
The study authors noted that prior research showed steep blood pressure increases occurring sooner in life among women than men. The cause of these observed differences in women with HIV is likely multifactorial, they contend, including ongoing inflammation, long-term antiretroviral therapy exposure, lower estrogen levels in menopausal women (which may occur earlier in WLWH than HIV-negative women), and social determinants of health.
The study also found that several other non-AIDS comorbidities occurred at higher rates, most notably (in order) chronic kidney disease, liver disease, cancer, psychiatric illness, dyslipidemia, and bone disease.
Age-based general population screening guidelines may be inadequate for PLWH, and especially for WLWH, study authors wrote. In addition to earlier screening, they called for sex-stratified guidelines and risk assessment tools that account for both HIV status and sex. “Our data highlight the need to prioritize WLWH, particularly young women, for early NACM screening to identify those at highest risk of amassing comorbidities and to offer timely, targeted risk-modification interventions,” they concluded.