High Burden of Age-Related Non-AIDS Comorbidities Among Women Living With HIV

The burden of age-related non-AIDS comorbidities (NACM) is particularly high among virologically suppressed women living with HIV and was found to be associated with non-HIV traditional risk factors, according to results of a study published in Clinical Infectious Diseases.

Study participants were virologically suppressed women living with HIV or women seronegative for HIV who were followed in the Women’s Interagency HIV Study. The median observation time was 15.3 years, the median age was 50 years, and median body mass index (BMI) was 30 kg/m². A total of 2309 women living with HIV and 923 seronegative women were included in the analysis.

Compared with seronegative participants, women living with HIV had higher systolic blood pressure (126 vs 122 mm Hg), BMI of 30 kg/m² or greater (57% vs 46%), and current use of cigarettes (44% vs 36%), alcohol (57% vs 41%), and crack/cocaine (9% vs 6%; all P <.0001). They also had a higher prevalence of chronic hepatitis C infection (13% vs 9%, P =.0026) and hepatitis B infection (2% vs 1%, P =.0148), as well as worse kidney function.

With each older age category, the mean NACM burden and individual NACM prevalence increased. Overall, women living with HIV had a higher mean NACM compared with seronegative women (3.6 vs 3.0; P <.0001). Psychiatric illness, liver disease, dyslipidemia, bone disease, chronic kidney disease, and non-AIDS cancer were all more prevalent in women living with HIV as well (P <.01 for all). There were no significant differences in prevalence of hypertension, lung disease, diabetes, and cardiovascular disease.

After controlling for race, BMI, education, income, marital status, whether they owned their residence, and current use of cigarettes, alcohol, and crack/cocaine, the estimated mean NACM was higher in women living with HIV compared with seronegative women in the age groups of 40 to 49 years (P <.0001) and 60 years and older (P =.0009). There was no difference for women younger than 40 or aged 50 to 59. Estimated mean NACM burden was also significantly higher in older, White women with HIV, those with a BMI of 30 kg/m² or higher, those with an income of $24 000 or less, and those who reported cigarette use, crack/cocaine use, or alcohol abstinence. The only HIV-related characteristics associated with NACM burden was recent use of abacavir.

The study was limited by reliance on self-reporting for several diagnoses and a lack of pathology and/or imaging modalities to supplement NACM definitions. The researchers were also limited in their ability to assess the contribution of specific types of combined antiretroviral therapy on individual NACMs. The role of menopause status and timing was also not investigated.

The researchers conclude that in the United States, women living with HIV experience a higher burden of age-associated NACMs compared with counterparts who are HIV seronegative. The study highlights the significant association between non-HIV risk factors and multimorbidity in this group of women and the need for clinical care guidelines that emphasize screening and intervention, said the investigators.

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

Reference

Collins LF, Sheth AN, Mehta CC, et al. The prevalence and burden of non-AIDS comorbidities among women living with or at risk for Human Immunodeficiency Virus infection in the United States. Clin Infect Dis. 2021;72(8):1301-1311. doi:10.1093/cid/ciaa204