Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

Abstract

Objectives: As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.

Design and setting: This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.

Participants: The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.

Primary and secondary outcome measures: The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer's and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.

Results: Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer's and/or dementia.

Conclusions: PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

Keywords: EPIDEMIOLOGY; Epidemiology; HIV & AIDS; PUBLIC HEALTH.

Figure 1

Treemaps of unadjusted 12-year prevalence of selected comorbidities throughout the study period; prevalence in PLWH and HIV-negative controls were significantly different (p value<0.0001), unless otherwise specified. Note: PLWH, people living with HIV; unless stated, there is a significant difference observed between prevalence in PLWH and HIV-negative controls (p value<0.0001); NS, non-significant difference observed between prevalence in PLWH and HIV-negative controls (p value>0.05); ALZD, Alzheimer’s and/or non-HIV-related dementia (denominator included only individuals aged 40 years and older); CANCER, non-AIDS-defining cancer; COPD, chronic obstructive pulmonary disease (denominator included only individuals aged 35 years and older); CVD, cardiovascular diseases; DM, diabetes mellitus; HTN, hypertension; KID, kidney diseases; LVR, liver diseases; OA, osteoarthritis.

Figure 2

Results of subanalysis of unadjusted 12-year prevalence of selected comorbidities among PLWH, stratified by ethnicity, history of injection drug use and sex at birth. Note: PLWH, people living with HIV; IDU PLWH, PLWH with a history of injection drug use; Non-IDU PLWH, PLWH without a history of injection drug use; ALZD, Alzheimer’s and/or non-HIV-related dementia; CANCER, non-AIDS-defining cancer; COPD, chronic obstructive pulmonary disease; CVD, cardiovascular diseases; DM, diabetes mellitus; HTN, hypertension; KID, kidney diseases; LVR, liver diseases; OA, osteoarthritis; *, significant difference in the prevalence of comorbidities among PLWH across IDU history and/or sex at birth groups (p value<0.05). Vertical scales differ for each graph for illustration purposes.

Figure 3

Annual trends of age-sex-standardised prevalence of selected comorbidities among PLWH and HIV-negative individuals across the study period (2001 to 2012) with 95% confidence intervals. Note: PLWH, people living with HIV. Vertical scales differ for each graph for illustration purposes.

Figure 4

Distribution of median age at diagnosis of selected comorbidities with 25^th and 75^th percentiles; unadjusted (overall) and stratified by rate of healthcare encounters prior to the diagnoses. Note: PLWH, people living with HIV; HIV Neg, HIV-negative controls; rates of healthcare encounters prior to a diagnosis (measured in number of encounters/person-year) were categorised as lowest (1); lower (2); higher (3); and highest (4). *, significant difference in the median age at diagnosis for PLWH and HIV-negative controls (p value<0.05). Vertical scales differ for each graph for illustration purposes.