Understanding the epidemiology of non-AIDS chronic co-morbidities (NACM) among aging HIV-infected (HIV+) persons is essential to optimize clinical care, and to plan health screening strategies. We evaluated number and types of NACMs in large diverse population of HIV+ adults on ART.
We studied HIV Outpatient Study (HOPS) patients at 8 U.S. HIV clinics, seen during 1/1/1997 to 6/30/2015, who were followed for a minimum of 5.0 years with ≥75% of observation time having viral load (VL) <200 copies/mL and on ART. In stratified analysis (by age at last observation:18-40, 41-50, 51-60, >61 years), we assessed number and types of NACMs documented in medical records anytime during HOPS observation and evaluated for differences in NACM prevalence and type by age group, sex, race, insurance type, HIV risk and HIV clinical factors. NACMs included were cardiovascular disease, cancer, hypertension, diabetes, dyslipidemia, arthritis, chronic HBV or HCV infection, anemia, and psychiatric illness.
Of 1540 patients, there were 1247 (81%) men, 406 (26%) non-Hispanic black, 183 (12%) Hispanic/Latino, 846 (55%) with private insurance, 575 (37%) with public insurance, 939 (61%) men who have sex with men (MSM), 375 (24%) heterosexuals and 125 (8%) with injection drug use history. Patients numbered 180, 502, 560, and 298, respectively, in the age strata 18-40, 41-50, 51-60, >61 years, with HOPS observation of a median of 10.8 years (range: min-max = 5.0-18.5). Mean number of NACMs increased by age category; 1.8, 2.6, 3.5, 4.3, respectively, (P<0.001). Overall prevalence of all NACMs increased with older age categories (P<0.001) except HBV and HCV infection and psychiatric illness (Figure). Significant differences (all P< 0.05) in mean number of NACMs were apparent by sex (women > men, 3.5 vs 3.1), race (blacks > non-blacks, 3.4 vs 3.1), and by insurance status (public > private, 3.9 vs 2.6). These differences were especially apparent in older age groups (51-60 and > 61 years, 3.5 and 4.3 vs 2.3 for ≤ 50 years of age), and were driven primarily by differences in specific NACMs: anemia, HCV, and diabetes.
We observed age-related increase in prevalence of NACMs and polymorbidity, with disproportionate burden most apparent among older women, blacks, and the publicly insured. These groups should be targeted for screening and prevention strategies aimed at risk reduction and disease intervention.