Disability-adjusted life years associated with chronic comorbidities among people living with and without HIV: Estimating health burden in British Columbia, Canada

Abstract

Life span of people living with HIV (PLWH) has increased dramatically with the advent of modern antiretroviral therapy. As a result, comorbidities have emerged as a significant concern in this population. To describe the burden of chronic comorbidities among PLWH and HIV-negative individuals in British Columbia (BC), Canada, we estimated disability-adjusted life years (DALYs) related to these comorbidities. Based on a population-based cohort in BC, antiretroviral-treated adult PLWH and 1:4 age-sex-matched HIV-negative controls were followed for ≥1 year during 2001-2012. DALYs combined years of life lost to premature mortality (YLLs) and due to disability (YLDs), and were estimated following the Global Burden of Diseases' approaches. DALYs associated with non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, dementia, cardiovascular (CVD), kidney, liver and chronic obstructive pulmonary diseases were each measured for 2008-2012. Among PLWH, DALYs attributed to non-AIDS-related cancers were also estimated for 2013-2020. We observed that at baseline, our matched cohort consisted of 82% males with a median age of 40 years (25th-75th percentiles: 34-47). During 2008-2012, 7042 PLWH and 30,640 HIV-negative individuals were alive, where PLWH experienced a twofold higher DALYs associated with chronic comorbidities (770.2 years/1000 people [95% credible intervals: 710.2, 831.6] vs. 359.0 [336.0, 382.2]). Non-AIDS-defining cancers and CVD contributed the highest DALYs in both populations, driven by YLLs rather than YLDs. Among PLWH, we estimated increasing DALYs attributable to non-AIDS-defining cancers with 91.7 years/1000 people (77.4, 106.0) in 2013 vs. 97.6 (81.0, 115.2) in 2020. In this study, we showed that PLWH experience a disproportionate burden of chronic comorbidities compared to HIV-negative individuals. The observed disparities may relate to differential health behaviors, residual HIV-related inflammation, and ART-related toxicities. As aging shapes future healthcare needs, our findings highlight the need to enhance prevention and management of comorbidities as part of HIV care.

Fig 1. Cumulative DALYs (2008–2012) per 1000 people, with 95% credible intervals, associated with nine selected chronic comorbidities, ranked from highest to lowest, by HIV status in British Columbia, Canada.

Note: PLWH: people living with HIV; DALYs: disability-adjusted life years; 95% CrI: 95% credible intervals; ALZD: Alzheimer’s and/or non-HIV-related dementia (denominator included only individuals aged 40 years and older); Cancers: non-AIDS-defining cancer; COPD: chronic obstructive pulmonary disease (denominator included only individuals aged 35 years and older); CVD: cardiovascular diseases; KID: kidney diseases; LVR: liver diseases. Horizontal scales differ between PLWH and HIV-negative controls for illustration purposes.

Fig 2. Cumulative YLLs (2008–2012) per 1000 people, with 95% credible intervals, associated with nine selected chronic comorbidities, ranked from highest to lowest, by HIV status in British Columbia, Canada.

Note: PLWH: people living with HIV; YLLs: years life lost due to premature mortality; 95% CrI: 95% credible intervals; ALZD: Alzheimer’s and/or non-HIV-related dementia (denominator included only individuals aged 40 years and older); Cancers: non-AIDS-defining cancer; COPD: chronic obstructive pulmonary disease (denominator included only individuals aged 35 years and older); CVD: cardiovascular diseases; KID: kidney diseases; LVR: liver diseases. Horizontal scales differ for each graph and between PLWH and HIV-negative controls for illustration purposes.

Fig 3. Cumulative YLDs (2008–2012) per 1000 people, with 95% credible intervals, associated with nine selected chronic comorbidities, ranked from highest to lowest, by HIV status in British Columbia, Canada.

Note: PLWH: people living with HIV; YLDs: years of healthy life lost due to disability; 95% CrI: 95% credible intervals; ALZD: Alzheimer’s and/or non-HIV-related dementia (denominator included only individuals aged 40 years and older); Cancers: non-AIDS-defining cancer; COPD: chronic obstructive pulmonary disease (denominator included only individuals aged 35 years and older); CVD: cardiovascular diseases; KID: kidney diseases; LVR: liver diseases. Horizontal scales differ for each graph and between PLWH and HIV-negative controls for illustration purposes.

Fig 4

Cumulative YLDs (2008–2012) per 1000 people, with 95% credible intervals, associated with nine selected chronic comorbidities among people living with HIV in British Columbia, Canada, stratified by ethnicity (A), history of injection drug use (B) and sex at birth (C). Note: PLWH: people living with HIV; YLDs: years of healthy life lost due to disability; PWID: PLWH who have ever injected drugs; ALZD: Alzheimer’s and/or non-HIV-related dementia; CANCERS: non-AIDS-defining cancers; COPD: chronic obstructive pulmonary disease; CVD: cardiovascular diseases; DM: diabetes mellitus; HTN: hypertension; KID: kidney diseases; LVR: liver diseases; OA: osteoarthritis. Vertical scales differ for each graph for illustration purposes.

Fig 5. Fitted (2002–2012) and predicted (2013–2020) DALYs, with 95% credible intervals, associated with non-AIDS-defining cancers among people living with HIV in British Columbia, Canada.

Note: DALYs: disability-adjusted life years. Direct age-sex-standardization was done using Canada’s 2011 census as reference population. Vertical scales differ for each graph for illustration purposes.