Background
Women vs men with HIV have a higher burden of aging-related multimorbidity, which may be related to reproductive transitions including pregnancy history.
Methods
We evaluated longitudinal data collected from women with and without HIV (WWH; WWoH) enrolled in the Women’s Interagency HIV Study and in follow-up on/after 2009 (when >80% of WWH consistently used antiretroviral therapy). We ascertained maternal age, number of prior live births (parity) and non-AIDS comorbidity (NACM) burden (of 10 assessed) at end of observation (latest 3/30/2020). Two-sample t-test compared NACM burden by HIV serostatus. Linear regression evaluated the association of parity with NACM burden. Within each age group, separate linear regression models assessed for synergistic effects of HIV and parity on NACM burden, adjusting for race/ethnicity, body mass index (BMI), and smoking.
Results
Among 3234 women, 71% were WWH, median age was 51 (Q1-Q3 44-57) years, 65% identified as Black race, median BMI was 30.2 (Q1-Q3 25.5-36.2) kg/m2 and 68% reported ever smoking cigarettes. At end of observation, 19%, 40%, and 41% of women reported 0, 1-2 and ≥3 prior live births; parity did not significantly differ by HIV serostatus (p=0.13). Median NACM burden was 4.0 vs 3.0 among WWH vs. WWoH (p<0.001). Among all women, the most prevalent NACM were hypertension (69%), psychiatric illness (55%) and dyslipidemia (42%). The estimated median NACM burden among women with 0, 1-2, ≥3 prior live births was 3.0, 3.0, and 4.0, respectively. In unadjusted analysis, parity was significantly associated with NACM burden (p for trend=0.02), regardless of HIV serostatus. In adjusted models, HIV modified the effect of parity (HIV*parity interaction) on NACM burden in certain age groups: <40yrs (p=0.29), 40-49yrs (p=0.02), 50-59yrs (p=0.39), ≥60yrs (p=0.93) (Figure).
Conclusions
In a large cohort of U.S. women with and without HIV, who had a high burden of aging-related comorbidities and >80% reporting ≥1 prior live birth, greater parity was associated with NACM burden. This effect was significantly modified by HIV among women aged 40-49 years, with some evidence of modification by HIV as women age. Our findings suggest parity may be a potential risk factor for aging-related multimorbidity and highlight the need for comorbidity screening and novel prevention strategies for persons with HIV using across-the-lifespan approaches that are tailored by sex and gender.