The Prevalence and Burden of Non-AIDS Comorbidities Among Women Living With or at Risk for Human Immunodeficiency Virus Infection in the United States

Abstract

Background: The prevalence and burden of age-related non-AIDS comorbidities (NACMs) are poorly characterized among women living with HIV (WLWH).

Methods: Virologically suppressed WLWH and HIV-seronegative participants followed in the Women's Interagency HIV Study (WIHS) through at least 2009 (when >80% of WLWH used antiretroviral therapy) were included, with outcomes measured through 31 March 2018. Covariates, NACM number, and prevalence were summarized at most recent WIHS visit. We used linear regression models to determine NACM burden by HIV serostatus and age.

Results: Among 3232 women (2309 WLWH, 923 HIV-seronegative) with median observation of 15.3 years, median age and body mass index (BMI) were 50 years and 30 kg/m2, respectively; 65% were black; 70% ever used cigarettes. WLWH had a higher mean NACM number than HIV-seronegative women (3.6 vs 3.0, P < .0001) and higher prevalence of psychiatric illness, dyslipidemia, non-AIDS cancer, kidney, liver, and bone disease (all P < .01). Prevalent hypertension, diabetes, and cardiovascular and lung disease did not differ by HIV serostatus. Estimated NACM burden was higher among WLWH versus HIV-seronegative women in those aged 40-49 (P < .0001) and ≥60 years (P = .0009) (HIV × age interaction, P = .0978). In adjusted analyses, NACM burden was associated with HIV, age, race, income, BMI, alcohol abstinence, cigarette, and crack/cocaine use; in WLWH, additional HIV-specific indices were not associated, aside from recent abacavir use.

Conclusions: Overall, NACM burden was high in the cohort, but higher in WLWH and in certain age groups. Non-HIV traditional risk factors were significantly associated with NACM burden in WLWH and should be prioritized in clinical guidelines for screening and intervention to mitigate comorbidity burden in this high-risk population.

Keywords: HIV and aging; comorbidity burden; human immunodeficiency virus; non-AIDS comorbidities; women living with HIV.

Figure 1.

Distribution of prevalent non-AIDS comorbidity burden by HIV serostatus and age group demonstrating that women living with HIV have a higher burden of comorbidities overall and specifically in age groups 40–49 and ≥60 years. Abbreviation: HIV, human immunodeficiency virus.

Figure 2.

Estimated number of non-AIDS comorbidities by HIV serostatus and age group, adjusted for HIV serostatus, categorized age, HIV × age interaction, in addition to the following demographic and clinical factors: race, BMI, education, income, marital status, own residence, and substance use (eg, cigarettes, crack/cocaine and alcohol). Abbreviations: BMI, body mass index; CI, confidence interval; HIV, human immunodeficiency virus; NACM, non-AIDS comorbidities.

Figure 3.

The 3 most common co-occurring non-AIDS comorbidity dyads in women living with or at risk for HIV infection, stratified by HIV serostatus and age group and ranked as most prevalent (1), second most prevalent (2), and third most prevalent (3) by each HIV × age stratum. The dyad of hypertension–psychiatric illness is represented in each stratification of HIV serostatus and age. Abbreviation: HIV, human immunodeficiency virus.