Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults

Abstract

Background: Although it has been shown that human immunodeficiency virus (HIV)-infected adults are at greater risk for aging-associated events, it remains unclear as to whether these events happen at similar, or younger ages, in HIV-infected compared with uninfected adults. The objective of this study was to compare the median age at, and risk of, incident diagnosis of 3 age-associated diseases in HIV-infected and demographically similar uninfected adults.

Methods: The study was nested in the clinical prospective Veterans Aging Cohort Study of HIV-infected and demographically matched uninfected veterans, from 1 April 2003 to 31 December 2010. The outcomes were validated diagnoses of myocardial infarction (MI), end-stage renal disease (ESRD), and non-AIDS-defining cancer (NADC). Differences in mean age at, and risk of, diagnosis by HIV status were estimated using multivariate linear regression models and Cox proportional hazards models, respectively.

Results: A total of 98 687 (31% HIV-infected and 69% uninfected) adults contributed >450 000 person-years and 689 MI, 1135 ESRD, and 4179 NADC incident diagnoses. Mean age at MI (adjusted mean difference, -0.11; 95% confidence interval [CI], -.59 to .37 years) and NADC (adjusted mean difference, -0.10 [95% CI, -.30 to .10] years) did not differ by HIV status. HIV-infected adults were diagnosed with ESRD at an average age of 5.5 months younger than uninfected adults (adjusted mean difference, -0.46 [95% CI, -.86 to -.07] years). HIV-infected adults had a greater risk of all 3 outcomes compared with uninfected adults after accounting for important confounders.

Conclusions: HIV-infected adults had a higher risk of these age-associated events, but they occurred at similar ages than those without HIV.

Keywords: HIV infection; aging; end-stage renal disease; myocardial infarction; non-AIDS-defining cancers.

Figure 1.

Overall and age-specific incidence rates (IRs) (and 95% confidence intervals [CIs]) for myocardial infarction (MI) (A), end-stage renal disease (ESRD) (B), non-AIDS-defining cancers (including human immunodeficiency virus [HIV]-associated cancers) (C), and HIV-associated cancers (D), by HIV status, Veterans Aging Cohort Study Virtual Cohort, April 2003–December 2010. HIV-associated cancers included anal, oral, penis, Hodgkin lymphoma, liver, and lung cancers. To estimate the person-years (PY) denominator for the IRs, participants were followed from their baseline date (ie, a participant's first clinical encounter on or after 1 April 2003) to the first occurrence of the outcome of interest, death, date of last follow-up, or 31 December 2010. Non-AIDS-defining cancers included anal, bladder, brain and nervous system, breast, colorectal, esophageal, Hodgkin lymphoma, kidney, larynx, leukemia (lymphoid and myeloid), liver, lung, melanoma, myeloma, oral cavity and pharynx, pancreatic, penis, prostate, soft tissue, stomach, testicular, thyroid (there were no cases of vulvar cancer).

Figure 2.

Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for myocardial infarction, Veterans Aging Cohort Study Virtual Cohort, April 2003–December 2010. Bold signifies statistically significant relationships with the outcome. aHRs and 95% CIs were estimated using Cox proportional hazards models. See Table 1 for definitions and measurement descriptions of the confounders depicted in the figure. Confounders with missing data were modeled with a separate category for missing. See the Supplementary Data for enumerated univariate (not shown) and multivariate (shown in this figure) point estimates and 95% CIs. Abbreviations: eGFR, estimated glomerular filtration rate; HIV, human immunodeficiency virus.

Figure 3.

Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for end-stage renal disease, by human immunodeficiency virus (HIV) status, Veterans Aging Cohort Study Virtual Cohort, April 2003–December 2010. Bold signifies statistically significant relationships with the outcome. aHRs and 95% CIs were estimated using Cox proportional hazards models. See Table 1 for definitions and measurement descriptions of the confounders depicted in the figure. Confounders with missing data were modeled with a separate category for missing. See the Supplementary Data for enumerated univariate (not shown) and multivariate (shown in this figure) point estimates and 95% CIs.

Figure 4.

Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for non-AIDS-defining cancers (including human immunodeficiency virus [HIV]-associated cancers), by HIV status, Veterans Aging Cohort Study Virtual Cohort, April 2003–December 2010. Bold signifies statistically significant relationships with the outcome. See Table 1 for definitions and measurement descriptions of the confounders depicted in the figure. Confounders with missing data were modeled with a separate category for missing. aHRs and 95% CIs were estimated using Cox proportional hazards models. See the Supplementary Data for enumerated univariate (not shown) and multivariate (shown in this figure) point estimates and 95% CIs. Abbreviation: eGFR, estimated glomerular filtration rate.