The Prevalence and Burden of Non-AIDS Comorbidities Among Women Living with or at-risk for HIV Infection in the United States Pubblico

Abstract

Background: Due to the success of combination antiretroviral therapy (cART), persons living with HIV are living longer. Age-associated non-AIDS comorbidities (NACM) increasingly account for morbidity and mortality in this population. Compared with HIV-seronegative counterparts, NACM occur up to a decade earlier among HIV-seropositive individuals, and women living with HIV (WLWH) may be at greater NACM risk than men. The epidemiology of NACM, however, is poorly characterized among WLWH. The objectives of this research were to describe NACM burden and prevalence, assess the effects of HIV serostatus and age on NACM burden, and describe risk factors associated with NACM, in a large U.S. cohort of women living with or at-risk for HIV infection.

 

Methods: Virologically-suppressed WLWH and HIV-seronegative participants followed in the Women’s Interagency HIV Study (WIHS) through ≥2009 (when >80% WLWH used cART) were included, with outcomes measured through 3/31/2018. Covariates, NACM number and prevalence were summarized at most recent WIHS visit. We used linear regression models to determine NACM burden by HIV serostatus and age.

 

Results: Among 3,232 women (2,309 WLWH, 923 HIV-seronegative) with median observation of 15.3 years, median age and body mass index (BMI) were 50 years and 30 kg/m² respectively, 65% were black, 70% ever used cigarettes. WLWH had a higher mean NACM number than HIV-seronegative women (3.6 vs. 3.0, p<0.0001) and higher prevalence of psychiatric illness, dyslipidemia, non-AIDS cancer, kidney, liver and bone disease (all p<0.01). Prevalent hypertension, diabetes, cardiovascular and lung disease did not differ by HIV serostatus. Estimated NACM burden was higher among WLWH vs. HIV-seronegative women in those aged 40-49 (p<0.0001) and ≥60 years (p=0.0009) (HIV*age interaction p=0.0978). In adjusted analyses, NACM burden was associated with HIV, age, race, income, BMI, alcohol abstinence, cigarette and crack/cocaine use; in WLWH, additional HIV-specific indices were not associated, aside from recent abacavir use.

 

Conclusions: Overall, NACM burden was high in the cohort, but higher in WLWH and in certain age groups. Non-HIV traditional risk factors were significantly associated with NACM burden in WLWH and should be prioritized in clinical guidelines for screening and intervention to mitigate comorbidity burden in this high-risk population.

Table of Contents

TABLE OF CONTENTS

INTRODUCTION ……………………………………………………………………… 1

BACKGROUND ……………………………………………………………………….. 2

METHODS .…………………………………………………………………………….. 6

RESULTS .……………………………………………………………………………. 12

DISCUSSION/CONCLUSIONS .…………………………………………………… 15

REFERENCES .……………………………………………………………………… 21

TABLES AND FIGURES ……………………………………………………………. 27

About this Master's Thesis

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School	Laney Graduate School
Department	Clinical Research
Degree	M.S.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Aging
Parola chiave	Non-AIDS comorbidities Aging with HIV HIV Women's health Women with HIV
Committee Chair / Thesis Advisor	Matthew Magee PhD, Emory University Igho Ofotokun MD MSc, Emory University
Committee Members	Anandi Sheth MD MSc, Emory University

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