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. 2022 Jul 15;101(28):e29850.
doi: 10.1097/MD.0000000000029850.

Cross-sectional comparison of age- and gender-related comorbidities in people living with HIV in Canada

Jason M Brunetta  1 , Jean-Guy Baril  2 , Joseph J de Wet  3 , Chris Fraser  4 , Gary Rubin  5 , Réjean Thomas  6 , Hugues Loemba  7 , Ken Logue  8 , Michael Silverman  9 , Jean Palmart  10 , Haiyan Jiang  11 , René-Pierre Lorgeoux  12 , Harout Tossonian  12 , Connie J Kim  13 , Alexander Wong  14
Affiliations

Cross-sectional comparison of age- and gender-related comorbidities in people living with HIV in Canada

Jason M Brunetta et al. Medicine (Baltimore). .

Abstract

Because antiretroviral therapy (ART) is allowing people living with human immunodeficiency virus (PLWH) to survive longer, they are developing more age-related comorbidities. We evaluated the effects of age and gender on the burden of age-related comorbidities among PLWH. In this retrospective real-world study, de-identified data were extracted from the medical charts of 2000 HIV-positive adults on ART across 10 sites in Canada. The prevalence of age-related comorbidities was determined in 6 age subgroups (<30, 30-39, 40-49, 50-59, 60-69, and ≥70 years). The effects of gender on these comorbidities were also examined. Risks of cardiovascular disease and chronic kidney disease (CKD) were calculated using the Framingham and D:A:D equations. Most persons were White (68%), male (87%), and virologically suppressed (94%). The mean age was 50.3 years (57% aged ≥50 years), and mean CD4+ T-cell count was 616 cells/mm3. The most common comorbidities were neuropsychiatric symptoms (61%), overweight/obesity (43%), liver disease (37%), and dyslipidemia (37%). The mean number of comorbidities increased across age subgroups (P < .001). Across all age subgroups, the prevalence of hypertension (P = .04), dyslipidemia (P = .04), CKD (P = .03), bone fragility (P = .03), and depression (P = .02) differed between males and females. Both age (P < .001) and gender (P < .001) impacted cardiovascular disease and CKD risk. Age and gender influenced the burden, types, and risks of age-related comorbidities in PLWH in this Canadian cohort. These comorbidities should be diagnosed and treated in routine clinical practice.

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Conflict of interest statement

J.M.B. received conference sponsorship from Gilead Sciences and ViiV Healthcare; consultancy fees from Gilead Sciences, ViiV Healthcare, and Merck; and speaker fees from Gilead Sciences. J.-G.B. reports grants to his institution from ViiV Healthcare, Gilead Sciences, and Merck and honoraria for consultancy, ad-boards, or conferences from ViiV Healthcare, Gilead Sciences, and Merck. J.J.d.W. served on advisory boards and as a speaker for ViiV Healthcare and Gilead Sciences. C.F. received funds for the development of hepatitis C virus learning modules for iCare Education Inc. (paid to Dr. Fraser) and funding for educational conferences, continuing medical education presentations, and clinical trials from AbbVie, Gilead Sciences, Merck, and ViiV Healthcare (paid to institution). G.R. is member of medical advisory boards for Gilead Sciences, Moderna, ViiV Healthcare, and Merck. R.T. received honoraria from Gilead Sciences for presentations, consultations, and advisory boards. His institution receives funding from Gilead Sciences for its HIV and preexposure prophylaxis databases and for intervention projects. K.L. received advisory board fees from ViiV Healthcare and Gilead Sciences. M.S. received consultation fees on advisory boards for Gilead Sciences and Merck. J.P. supplied data collection and management services, which were funded by Gilead Sciences Canada. R.-P.L. is an employee of Gilead Sciences Canada. H.T. is a former employee of Gilead Sciences Canada. K.J.K. is an employee of Gilead Sciences, Inc. and a former employee of Gilead Sciences Canada. A.W. received consulting fees and honoraria from Merck, Gilead Sciences, and ViiV Healthcare; received funding for regional and provincial programming from Merck, Gilead Sciences, and ViiV Healthcare; and currently participates in clinical trials for Merck, Gilead Sciences, and ViiV Healthcare. H.L. and H.J. have no conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Comorbidity burden by age group. (A) Number of comorbidities and (B) prevalence of specific comorbidities. Cochran–Mantel–Haenszel tests were used to examine the association between age group and comorbidities. *P < .05. **P < .001. CKD = chronic kidney disease, CVD = cardiovascular disease, HIV = human immunodeficiency virus.
Figure 2.
Figure 2.
Prevalence of specific comorbidities in subgroups defined by age-plus-gender. Conditional logistic regression was used to obtain the P values for the gender differences. For each comorbidity, the model included 2 covariates: age group and gender, stratified by study site. CKD = chronic kidney disease, CVD = cardiovascular disease.
Figure 3.
Figure 3.
Effects of age and gender on CVD risk per the A, 10-year Framingham test and B, 1-year D:A:D calculation. Analyses were undertaken using multinomial logistic regression.(A) Study site adjusted in the model as a nuisance parameter. (B) The model did not adjust for study site because of limited sample size. CI = confidence interval, CVD = cardiovascular disease, D:A:D = Data Collection on Adverse Events of Anti-HIV Drugs, OR = odds ratio.
Figure 4.
Figure 4.
Effects of age and gender on CKD risk per the D:A:D CKD risk calculation. Analysis was undertaken using multinomial logistic regression. The model did not adjust for study site because of limited sample size. CI = confidence interval, CKD = chronic kidney disease, D:A:D = Data Collection on Adverse Events of Anti-HIV Drugs, OR = odds ratio.
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