Background
Antiretroviral therapy (ART) has transformed HIV from a life-threatening infection into a manageable chronic condition, allowing people living with HIV (PLWH) to have a significantly longer lifespan. However, as this population ages, they become increasingly susceptible to non-AIDS-related comorbidities typically associated with aging. Understanding the evolving patterns of these age-related conditions is essential to optimize care for this group. In this study, we analyzed trends in severe non-AIDS events (SNAEs) over different time periods to provide insights into how advances in HIV management have impacted the onset and frequency of these comorbidities.
Methods
Using CoRIS, a Spanish multicenter prospective cohort with more than 20,000 PLWH, we defined three six-year periods: 2006–2011, 2012–2017, and 2018–2023. The primary outcome was a diagnosis of a severe non-AIDS event (SNAE) during follow-up. SNAE was defined as a composite event, including major adverse cardiovascular events (MACE), non-AIDS-defining malignancies, and non-accidental deaths. MACE included nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death. We used the Kaplan-Meier method to plot the cumulative probabilities of events for each defined period. We used Cox proportional hazard models to assess the hazard ratios (HR) of events by period adjusted for age, sex, educational level, risk practice, geographic origin, CD4 nadir, baseline CD4/CD8, and baseline VL. We used linear regression to predict the mean age at first event in each period, using the same covariates.
Results
A total of 18,659 ART-naïve participants were enrolled in the cohort between 2006 and 2023. The incidence of SNAEs in each period was 1.44 (95%CI 1.29-1.61), 0.95 (95%CI 0.83-1.08), and 0.67 (95%CI 0.57-0.79) per 1000 person-years, respectively (p<0.001; Figure 1A). The adjusted HR for SNAEs compared to period 1 was 0.81 (95%CI 0.66-0.99) in period 2 and 0.58 (95%CI 0.45-0.73) in period 3. The adjusted predicted age for the first event was 42.2 (95%CI 39.8-44.6), 45.6 (95%CI 43.5-47.8), and 48.3 (95%CI 45.4-51.3) years, respectively (Figure 1B).
Conclusions
The incidence of severe non-AIDS events among PLWH has decreased significantly over time, with a notable delay in the age of onset of these events. This could indicate that improvements in HIV treatment and care contribute to healthier aging in this population.