High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC

Abstract

Objectives: With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates.

Methods: Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results.

Results: Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities.

Conclusions: These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.

Keywords: HIV; diabetes; dyslipidaemia; hypertension; metabolic comorbidities; obesity.

Figure 1

Bar graphs of the prevalence of metabolic comorbidities (a) among all HIV patients in the DC Cohort and by (b) sex at birth, (c) age group, and (d) race/ethnicity, 1/1/2011-6/30/2015 (n=7018).

Figure 2. Venn diagrams of the proportions of HIV patients with (a) hypertension (n=3497), (b) type 2 diabetes (n=902), (c) dyslipidemia (n=3370), and (d) obesity (n=2469) who met criteria for these metabolic comorbidities based on diagnoses, medications, and/or test results

Of the 902 patients classified as having type 2 diabetes, 30% had evidence of elevated serum glucose, 40% had evidence of elevated HbA1c, and 51% had evidence of either elevated serum glucose or elevated HbA1c; the latter of these is depicted by the blue circle in Figure 2b. Of the 3370 patients classified as dyslipidemic, 52% had evidence of elevated total cholesterol, 46% had evidence of low HDL-C, and 80% had evidence of either elevated total cholesterol or low HDL-C; the latter of these is depicted by the blue circle in Figure 2c.