The growing uptake of antiretroviral therapy (ART) has resulted in an increase in the lifespan of persons with HIV (PWH); however, aging-related non-AIDS comorbidities (NACM) are now on the rise and present a new health challenge. PWH have a higher burden of comorbidities and these comorbidities begin earlier than in the general population. Furthermore, data suggests that there are stark sex differences in NACM risk and severity. The increased burden of comorbidities can lead to reduced quality of life, premature mortality, and increased health care needs and spending. A better understanding of the differences in presentation and incidence of NACM in men and women living with HIV will inform better intervention approaches for this growing public health concern.
This cross-sectional study examined the differences in burden of NACM in women and men with and without HIV to assess distribution and severity. The analysis included approximately ten years of data from women and men enrolled in HIV/AIDS cohort studies and similar individuals who are seronegative for HIV for comparison. Ten aging-related NACM were examined (hypertension, dyslipidemia, diabetes, cardiovascular disease, kidney disease, liver disease, lung disease, bone disease, psychiatric illness, and non-AIDS cancer). The burden and prevalence of these comorbidities were the primary measures of the study. The most prevalent NACM in PWH were found to be hypertension, psychiatric illness, dyslipidemia, liver disease, and bone disease. Prevalence of bone disease, lung disease, and diabetes was higher in women than men. Consistent with findings from other studies, the overall burden of aging-related comorbidities was higher in women than men, particularly among PWH.
The findings of this study support the need to further define the distribution and severity of NACM by sex and gender to improve strategies to support healthy aging in PWH. Clinical guidance and tools are needed to accurately identify PWH at risk of multimorbidity to offer more timely interventions. Additional research is needed to further understand the impacts of HIV and aging across the lifespan for women, including the effects of menopause transition on the progression of comorbidities.
References:
Collins, LF et al. Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019. JAMA Netw Open. DOI 10.1001/jamanetworkopen.2023.27584