Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Oct 14;2(10):e0001138.
doi: 10.1371/journal.pgph.0001138. eCollection 2022.

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

Ni Gusti Ayu Nanditha  1   2 , Jielin Zhu  1 , Lu Wang  1 , Jacek Kopec  3   4 , Robert S Hogg  1   5 , Julio S G Montaner  1   2 , Viviane D Lima  1   2
Affiliations

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

Ni Gusti Ayu Nanditha et al. PLOS Glob Public Health. .

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.

PubMed Disclaimer

Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: JSGM’s institutional grants have been provided by Gilead, J&J, Merck and ViiV Healthcare. All other authors have no competing interests to declare.

Figures

Fig 1
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
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
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
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
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.
See this image and copyright information in PMC

References

    1. Wing EJ. HIV and aging. Int J Infect Dis [Internet]. 2016. Dec 1 [cited 2018 Apr 24];53:61–8. Available from: https://www.sciencedirect.com/science/article/pii/S1201971216311870 doi: 10.1016/j.ijid.2016.10.004 - DOI - PubMed
    1. Collaboration TATC. Causes of Death in HIV-1—Infected Patients Treated with Antiretroviral Therapy, 1996–2006: Collaborative Analysis of 13 HIV Cohort Studies. Clin Infect Dis [Internet]. 2010. May 15;50(10):1387–96. Available from: doi: 10.1086/652283 - DOI - PMC - PubMed
    1. Lima VD, Lourenço L, Yip B, Hogg RS, Phillips P, Montaner JSG. AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: A retrospective study. Lancet HIV [Internet]. 2015 Mar [cited 2018 Apr 24];2(3):92–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25780802 doi: 10.1016/S2352-3018(15)00017-X - DOI - PMC - PubMed
    1. Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al.. Premature Age-Related Comorbidities Among HIV-Infected Persons Compared With the General Population. Clin Infect Dis [Internet]. 2011. Dec 1 [cited 2019 Feb 8];53(11):1120–6. Available from: https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cir627 doi: 10.1093/cid/cir627 - DOI - DOI - PubMed
    1. Justice A, Falutz J. Aging and HIV: an evolving understanding. Curr Opin HIV AIDS [Internet]. 2014. Jul [cited 2019 Feb 4];9(4):291–3. http://www.ncbi.nlm.nih.gov/pubmed/24871091 - PMC - PubMed