People living with HIV are increasingly experiencing a range of
non-AIDS-related co-morbidities as the population ages, including cardiovascular
disease, kidney impairment and bone loss leading to fractures, according to
research presented at the IDWeek 2016 meeting in New Orleans in October.
Thanks to effective antiretroviral therapy (ART), more HIV-positive
people in the US and Europe are surviving to older ages. Estimates indicate
that nearly half of people living with HIV in the US are aged 50 or older. While
some research has found that HIV-positive people who were treated promptly with
modern ART may have a life expectancy close to that of HIV-negative
individuals, those who developed advanced immune deficiency or were treated
with suboptimal therapy often have ongoing health problems.
Studies have shown that people with HIV are at higher risk for developing
chronic non-AIDS conditions such as heart disease and cancer, and they may do
so at younger ages. Some of these conditions have been linked to specific
antiretroviral drugs, including kidney impairment and bone loss with tenofovir
(Viread) and cardiovascular events
with abacavir (Ziagen).
Xue Song of Truven Health Analytics and colleagues
compared rates of co-morbid conditions and trends over time among HIV-positive
and HIV-negative people.
Using Truven Health MarketScan Databases, the
researchers selected more than 37,000 adults diagnosed with HIV and treated
with ART from 2003 to 2013. The databases included more than 41 million people
with commercial health coverage and about 8 million Medicaid enrollees from
multiple states. HIV-positive people were matched with up to three HIV-negative
control subjects based on demographic variables, region and type of health
The analysis included 21,180 HIV-positive people and
66,027 HIV-negative controls with commercial health coverage. Most (84%) were
men, the mean age was approximately 48 years and 12% were over age 50. In
addition, there were 16,431 people with HIV and 45,556 controls on Medicaid. In
this group only about half (53%) were men and the mean age was about 50 years.
People with HIV were found to have significantly
higher co-morbidity rates that HIV-negative people, and people on Medicaid
generally had more health problems than those with commercial coverage.
cohort: 7% of HIV-positive vs 4% of HIV-negative people
cohort: 11% vs 8%, respectively.
cohort: 9% vs 3%
cohort: 15% vs 6%.
cohort: 8% vs 6%
cohort: 13% vs 10%.
Other co-morbidities were more common, but occurred
with similar frequency among people with and without HIV.
cohort: 31% of HIV-positive vs 30% of HIV-negative people
cohort: 37% vs 34%, respectively.
cohort: 31% vs 30%
cohort: 22% vs 24%.
cohort: 21% vs 18%
cohort: 26% vs 25%.
People with HIV were much more likely than
HIV-negative people to have hepatitis C, in the commercial cohort (5% vs 1%)
and especially in the Medicaid cohort (23% vs 4%).
Between 2003 and 2013 the media age of ART-treated
people with HIV rose in both the commercial (from 44 to 48 years) and Medicaid
(from 42 to 48 years) cohorts.
Among people with HIV in the commercial cohort, the
proportion with co-morbidities increased between 2003 and 2013 for diabetes
(from 6% to 9%), hypertension (10% to 25%), hyperlipidaemia (10% to 23%),
obesity (1% to 5%) and endocrine disease (10% to 16%).
Co-morbidities increased even more over time in the
HIV-positive Medicaid cohort: diabetes (from 9% to 17%), hypertension (16% to
47%), hyperlipidaemia (8% to 29%), obesity (2% to 12%) and endocrine disease
(14% to 24%).
Rates of cardiovascular events, kidney
impairment and fractures rose from 2003 to 2013 in both the HIV-positive and
HIV-negative groups with either commercial coverage or Medicaid, but the
proportion with these three co-morbidities was consistently higher among
"HIV patients have multiple
non-AIDS-related comorbidities, including risk factors for renal impairment,
cardiovascular disease, and fracture/osteoporosis," the researchers
concluded. "Among treated HIV patients, the prevalence of comorbidities is
increasing over time, especially renal, bone and cardiovascular
Dr Song noted that commercially insured individuals
are typically the healthiest population in the US with the best access to
health care, so their data represents co-morbidities among the best-served
patients with HIV.
Medicaid patients had higher rates of co-morbidities than commercial
patients despite similar ages. In addition, the Medicaid population had more
turn-over and had greater differences in co-morbidity rates between
HIV-positive and HIV-negative people.
As a limitation, the researchers noted that these
findings may not be generalisable to people with other types of health care
coverage or with no insurance.