Characteristics of the MACS/WIHS Combined Cohort Study: Opportunities for Research on Aging With HIV in the Longest US Observational Study of HIV

Abstract

In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women's Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018-September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48-63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research.

Keywords: HIV; MACS/WIHS Combined Cohort Study; Multicenter AIDS Cohort Study; Women’s Interagency HIV Study; biorepositories; cohort studies; collaborative research; comorbidity.

Figure 1

Distributions of cluster of differentiation 4 (CD4) cell counts (A) and plasma human immunodeficiency virus (HIV) viral RNA loads (B) among current Multicenter AIDS Cohort Study and Women’s Interagency HIV Study participants living with HIV, by year, 1995–2019. Data were restricted to current participants, and we used semiannual CD4 cell counts and HIV viral RNA load measures to explore these trends. CD4 cell count categories, from top to bottom (A): blue, ≥500 cells/mm³; lighter pink, 350–499 cells/mm³; darker pink, 200–349 cells/mm³; red, <200 cells/mm³. HIV RNA viral load categories, from top left to bottom right (B): red, >10,000 copies/mL; darker pink, 1,001–10,000 copies/mL; lighter pink, 81–1,000 copies/mL; lighter blue, ≤80 copies/mL; darker blue, ≤20 copies/mL. AIDS, acquired immunodeficiency syndrome.

Figure 2

Geographic locations of MACS/WIHS Combined Cohort Study sites across the United States, 2020. AIDS, acquired immunodeficiency syndrome; AL, Alabama; CA, California; DC, District of Columbia; FL, Florida; GA, Georgia; HIV, human immunodeficiency virus; IL, Illinois; MACS, Multicenter AIDS Cohort Study; MD, Maryland; MS, Mississippi; NC, North Carolina; NY, New York; OH, Ohio; PA, Pennsylvania; WIHS, Women’s Interagency HIV Study.

Figure 3

Distributions of current MACS/WIHS Combined Cohort Study (MWCCS) participants living with human immunodeficiency virus (HIV) according to age (A) and race/ethnicity (B), by sex and compared with all people living with HIV in the United States (8), October 2018–September 2019. AIDS, acquired immunodeficiency syndrome; MACS, Multicenter AIDS Cohort Study; WIHS, Women’s Interagency HIV Study. The “Other” category comprises Asian, Native Hawaiian/other Pacific Islander, Native American/Alaska Native, and other races/multiracial.

Figure 4

Lessons learned from merging the Multicenter AIDS Cohort Study (MACS) and Women’s Interagency HIV Study (WIHS) cohorts into the MACS/WIHS Combined Cohort Study. AIDS, acquired immunodeficiency syndrome; HIV, human immunodeficiency virus; sIRB, single institutional review board.