- Researchers compared health-related data from HIV-positive and HIV-negative people
- They found that HIV-positive people were more likely to develop age-related complications
- HIV-positive people developed Alzheimer’s and other non-HIV-related dementia prematurely
When used as directed, potent combination HIV treatment (ART) can greatly reduce the amount of HIV in the blood. Continued use of ART allows the immune system to effect sufficient repairs that the risk of AIDS-related infections becomes very rare. The power of HIV treatment is so transformative that scientists expect many ART users to have near-normal life expectancy.
As a result of longer lifespan, many HIV-positive people are having to cope with issues related to aging, in some cases prematurely.
A team of researchers at the British Columbia Centre for Excellence in HIV/AIDS compared health-related information between about 8,000 HIV-positive people and 32,000 HIV-negative people. The researchers were interested in the onset of health conditions generally related to aging (comorbidities).
Over the course of the study (about a decade), researchers found that HIV-positive people accumulated more comorbidities than HIV-negative people. Furthermore, comorbidities tended to occur earlier among HIV-positive people.
The researchers stated that the findings from their study underscore the need for “optimized screening for comorbidities at earlier ages among [HIV-positive people], and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions.”
Study details
The research team assembled, combined and compared health-related information from many databases and a study called “COAST.” The COAST study captured information from about 8,000 HIV-positive people in B.C. as well as what the researchers called a “random representative sample of B.C.’s population followed from 1996 to 2013.”
All participants were at least 19 years old when they entered the study. All HIV-positive people were taking ART. Data from each HIV-positive person were matched and compared to data from four randomly selected HIV-negative people of the same age and gender.
The researchers focused on the following nine comorbidities:
- Alzheimer’s and other non-HIV-related dementia
- higher-than-normal blood pressure
- cancers unrelated to HIV
- cardiovascular disease
- chronic obstructive pulmonary disease (COPD)
- diabetes
- kidney disease
- liver disease
- osteoarthritis
For the present analysis, researchers focused on the time period between January 1, 2001 and December 31, 2012. In total, there were 8,031 HIV-positive people. Their average profile at the start of the study was as follows (note that figures may not total 100 due to rounding):
- 82% men, 18% women
- age distribution: under 30 years – 12%; between 30 and 39 years – 36%; between 40 and 49 years – 35%; 50 and older – 18%
- substance use distribution: injection drug use – 38%; no injection drug use – 35%; no data in file about whether or not the person used drugs – 26%
Results
Overall, according to the researchers, HIV-positive people “experienced a greater disease burden compared with HIV-negative controls, driven by significantly higher prevalence of most chronic age-associated comorbidities throughout the study period.” The exceptions to this trend were as follows:
- higher-than-normal blood pressure (more common in HIV-negative people)
- osteoarthritis – rates were not significantly different between the two study populations
Sub-group analyses
When researchers focused on HIV-positive people with a known history of injecting street drugs vs. HIV-negative people, they found significantly elevated rates of the following conditions:
- Alzheimer’s disease and other non-HIV-related dementia
- COPD
- kidney disease
- liver disease
When researchers focused on HIV-positive women, they found a greater burden of the following diseases:
- kidney disease
- liver disease
Readers should note that this finding is probably related more to injecting street drugs than to any biological relationship with gender.
Age
Overall, according to the researchers, HIV-positive people were diagnosed with most comorbidities at a significantly younger age than their HIV-negative counterparts. The exceptions to this were diabetes and higher-than-normal blood pressure.
The researchers found that the greatest differences in age of diagnosis between HIV-positive and HIV-negative people occurred with the following conditions:
- Alzheimer’s and other non-HIV-related dementia – 13 years
- kidney disease – 10 years
- COPD – 6 years
- liver disease – 5 years
An important factor
One factor that could have affected the study’s findings is as follows: It is likely that HIV-positive people visited healthcare providers more often. This increase in encounters with healthcare providers could increase the chances that some, perhaps all, comorbidities would be diagnosed earlier among HIV-positive people. In the present study, overall, HIV-positive people had between two- to three-fold more encounters with healthcare providers than HIV-negative people. To minimize potential biases when interpreting the results, the researchers then restricted their analysis to only HIV-positive and HIV-negative people who had similar rates of clinical encounters.
Using this analysis, the researchers stated that HIV-positive people “were still diagnosed with cancer, COPD, cardiovascular disease, kidney and liver diseases at significantly younger ages; between one to 10 years earlier.”
Brain health and related issues
When the researchers focused on the differences in the age of diagnosis of Alzheimer’s disease and other non-HIV-related dementia, they stated that they “uncovered an even larger difference, between 14 to 21 years earlier.” That is, on average, HIV-positive people developed Alzheimer’s disease and other non-HIV-related dementia earlier than HIV-negative people. This particular difference seems unusually premature and it would be interesting to learn of results of other large studies on aging and HIV regarding Alzheimer’s disease and non-HIV-related dementia.
However, the results reflect what happened in the population studied in B.C., where about 0.4% of HIV-negative people were diagnosed with Alzheimer’s disease and other non-HIV-related dementia, and among HIV-positive people the figure was 3.6%.
A more in-depth analysis, using patients’ medical records rather than administrative databases, might yield background information about the heightened risk for cognitive impairment found among HIV-positive people. In the current study, people who injected street drugs were at particular risk for premature onset of Alzheimer’s disease and other non-HIV-related dementia. There may need to be more studies on the impact of substance use on brain health over the long term.
Note that in the B.C. study researchers found that HIV-positive participants had a higher burden of comorbidities than HIV-negative people of the same age and gender. This higher burden of comorbidities may have had an impact on their risk for diseases affecting the brain, as found in a U.S. study below.
A study in Ohio, which took place roughly around the same time as the one in B.C., enrolled 47,862 people with HIV—30,828 of whom were taking ART and 17,034 not on ART. The study found that, in general, ART users had a reduced risk for any form of dementia. However, they also found that participants who had comorbidities “including cardiac arrhythmia, paralysis, other neurological disorders, complicated diabetes, hypothyroidism, renal failure, lymphoma, rheumatoid arthritis, weight loss, and depression” were at heightened risk of some form of neurocognitive impairment, including dementia. This finding underscores the connection between comorbidities and brain health.
For the future
The B.C. researchers stated that their findings “support the prevention and management of these comorbidities as an increasingly important public health priority for [HIV-positive people] and their healthcare providers.”
—Sean R. Hosein
Resources
British Columbia Centre for Excellence in HIV/AIDS
Canadian HIV Trials Network (CTN)
Studying patterns of healthy aging among HIV-positive people in Canada – CATIE News
Factors affecting frailty in middle-aged HIV-positive people – CATIE News
Managing medicines may become more difficult as some HIV-positive people age – CATIE News
High rates of frailty seen among middle-aged and older HIV-positive people in Alberta – CATIE News
Exploring the impact of aging on the brains of HIV-positive and HIV-negative people – CATIE News
REFERENCES:
- Nanditha NGA, Paiero A, Tafessu HM, et al. Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study. BMJ Open. 2021 Jan 8;11(1):e041734.
- Samji H, Cescon A, Hogg RS, et al; for the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA. Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada. PLoS One. 2013 Dec 18;8(12):e81355.
- Siangphoe U, Archer KJ, Nguyen C, et al. Associations of antiretroviral therapy and comorbidities with neurocognitive outcomes in HIV-1-infected patients. AIDS. 2020 May 1;34(6):893-902.
- Milanini B, Samboju V, Cobigo Y, et al. Longitudinal brain atrophy patterns and neuropsychological performance in older adults with HIV-associated neurocognitive disorder compared with early Alzheimer’s disease. Neurobiology of Aging. 2019 Oct;82:69-76.
- De Francesco D, Wit FW, Bürkle A, et al; for the Co-morBidity in Relation to AIDS (COBRA) Collaboration. Do people living with HIV experience greater age advancement than their HIV-negative counterparts? AIDS. 2019 Feb 1;33(2):259-268.