Older people with HIV have an increased risk of numerous chronic illnesses associated with older age, investigators from the United States report in Scientific Reports. These conditions included diabetes, cardiovascular disease, stroke, lung disease and dementia. The researchers from the University of Southern California demonstrated that the association between HIV and chronic disease risk in older age was independent of the demographic and behavioural factors and other co-morbidities.
Interestingly, people diagnosed with HIV more than two years after enrolling in insurance had a higher risk of chronic disease. This group may have been living with undiagnosed HIV until later in life or may have acquired HIV over the age of 50 (as all study participants were above this age).
“We found that people living with HIV and AIDS were more likely to have chronic conditions even after controlling for demographic characteristics, behavioural risk factors, and other chronic comorbidities,” comment the authors. “Our findings were robust at different follow-up periods of analysis and under different model specifics.”
HIV was shown to have an impact on chronic disease risk comparable to that associated with smoking, underlining the importance of monitoring for and treating diseases associated with older age in people with HIV.
Many people with HIV have an excellent prognosis and can expect to live well into older age. In the US, approximately 50% of all HIV-positive individuals are now aged over 50 and diseases associated with older age are now an important cause of serious illnesses and death in these individuals. Moreover, people with HIV appear to develop such illnesses at a younger age than their HIV-negative peers.
A group of researchers led by Dr Hsin-Yun Yang of the University of Southern California wanted to gain a clearer association of the association between living with HIV and the onset of chronic diseases. In particular, they wanted to see if infection with HIV increased the risk of such diseases independent of demographic and lifestyle factors, and also the presence of pre-existing co-morbidities. The latter is important as many chronic conditions can interact, such as diabetes which elevates the risk of cardiovascular disease.
They therefore designed a study using the medical records of over 9,000,000 people who received medical care via enrollment in a private insurance plan between 2007 and 2016. All were aged 50 years and above. Approximately 25,000 were HIV positive.
Seven chronic diseases were of interest to the researchers: diabetes, hypertension (high blood pressure), stroke, cancers, lung disease, cardiovascular disease, and cognitive impairment.
The characteristics of the participants differed according to their HIV status. People with HIV were more likely to be male (74% vs 46%), black (29% vs 10%) and have an annual income below $50,000 (46% vs 33%).
Those with HIV were also more likely to have a number of behavioural and lifestyle factors associated with poorer health outcomes, including alcohol-related disease (2.0% vs 0.7%), substance abuse (0.6% vs 0.1%) and smoking (22% vs 11%). These risk factors were controlled for in some of their analyses.
There were also differences within the HIV group according to the time of HIV diagnosis. Notably, individuals who were diagnosed with HIV more than two years after joining their insurance plan were older, more likely to be female and had higher rates of obesity, alcohol abuse and several chronic diseases – diabetes, hypertension, cardiovascular disease and cognitive impairment.
The average duration of enrolment in an insurance plan was approximately 4.5 years. Average age at enrolment was 59 years for people with HIV and 64 years for the HIV-negative individuals.
Overall, rates of chronic diseases at the time of enrolment were higher among people with HIV. This included diabetes (29% vs 24%), hypertension (47% vs 46%), stroke (3% vs 2%), lung disease (14% vs 11%), cardiovascular disease (22% vs 21%), and dementia (9% vs 8%), but not cancer.
The investigators found that, after taking into account demographics, lifestyle factors and pre-existing illnesses, people with HIV were at increased risk of having a new diagnosis of every single one of the chronic diseases examined in the study. This was the case after two, five and ten years of follow-up. Having HIV increased the risk of developing a chronic illness by between 10 and 80% – the risk was greatest for cognitive impairment and dementia.
The researchers noted that the level of the risk associated with HIV was similar to that for established risk factors for chronic diseases, especially smoking.
People diagnosed with HIV two or more years after enrollment in their insurance plan had an especially high risk of being diagnosed with a new-onset chronic disease. The authors suggest that this could be due to late diagnosis of HIV.
The investigators did not have information on the overall amount of time participants had been living with HIV, type of antiretroviral therapy or adherence. But they stress that the study had a large sample size and that they were able to take into account multiple factors that could have affected the risk of developing a chronic disease.
“With an aging people living with HIV and AIDS population, both medical practitioners and health policymakers must understand the risks this growing vulnerable population faces as they are exposed to conclude the authors. “We hope that the findings in this study will contribute to a growing body of literature which will help our healthcare systems prepare for a rapidly increasing population of aging people living with HIV and AIDS.”
H-Y Yang et al. Chronic disease onset among people living with HIV and AIDS in a large private insurance claims dataset. Scientific Reports, 9: 18514, 2019 (open access).