Aging-Related Comorbidity Burden Higher in Women vs Men With HIV

Results of a study published in JAMA Network Open suggest that the overall burden of aging-related comorbidities is significantly higher in women compared with men, particularly among those with HIV infection.

Researchers in the United States conducted a cross-sectional analysis from 2008 to 2019 to evaluate the relationship between HIV infection and the burden of aging-related comorbidities. Eligible patients included adults with and without HIV infection with comparable sociodemographic characteristics. The primary outcome was comorbidity burden, defined as the total number of aging-related non-AIDS comorbidities out of 10 assessed. The secondary outcome was individual comorbidity prevalence. The effects of HIV status, age, and sex on comorbidity burden were explored via linear regression.

The analysis included a total of 5929 patients, of whom the median age was 54 (IQR, 46-61) years, 3238 (55%) were women, 2691 (45%) were men, 47% were Black, 34% were White, and 19% were Hispanic or of unknown race/ethnicity. Among women and men, 2316 and 1452 had HIV infection, 922 and 1239 were seronegative for HIV infection, and 37% and 21% were active smokers, respectively. Of HIV-positive women and men, the median CD4⁺ count was 620 and 636 cells/mm³, and 81% and 86% had HIV viral loads below 200 copies/mL, respectively.

The researchers observed a relationship between increasing age category and progressively higher mean (SD) aging-related comorbidity burden, ranging from 1.41 (1.32) in patients younger than 40 to 4.41 (1.73) in those aged 70 years and older (P <.001).

Patients with vs without HIV infection had an overall higher mean (SD) comorbidity burden (3.47 [1.99)] vs 3.03 [1.86]; P <.001). Similar results were observed after HIV-positive patients were stratified by age.

Additional analysis showed that the mean (SD) comorbidity burden was higher among women vs men (3.36 [2.08] vs 3.24 [1.79]; P =.02) in the overall population.

Women vs men showed higher prevalence of bone disease (42% vs 19%), lung disease (38% vs 10%), and diabetes (24% vs 17%). Men, however, had higher prevalence of hypertension (75% vs 68%), psychiatric illness (58% vs 55%), dyslipidemia (64% vs 41%), liver disease (38% vs 34%), and non-AIDS-related cancer (12% vs 7%). Cardiovascular and kidney disease prevalence did not significantly differ by sex.

In the adjusted analysis, the mean (SD) number of comorbidities in HIV-positive patients was 0.31 (0.09) higher among women (3.63; 95% CI, 3.46-3.79) vs men (3.32; 95% CI, 3.16-3.48).

Limitations of this study include the inability to control for time-varying covariates such as longitudinal viremia, menopausal transition, cumulative antiretroviral therapy use, and the use of specific therapies for aging-related comorbidities. Moreover, variations in patient characteristics and aging-related comorbidity burden by sex may have resulted from differences in enrollment criteria. These findings also may not be generalizable among all US patients with HIV infection.

According to the researchers, “Our findings underscore the need to accurately identify PWH [people with HIV] at risk of multimorbidity to offer timely and tailored-risk modification interventions, with consideration given to sex and gender…”

Disclosures: Multiple study authors declared affiliations with pharmaceutical, biotech, and/or device companies. Please see the original reference for a full list of disclosures.