The research was conducted as a cross-sectional analysis using medical chart data from a total of 416 patients treated at the Hospital de Clínicas de Porto Alegre, a tertiary referral hospital in south Brazil, Rafael Aguilar Maciel, MD of the Universidade Federal do Rio Grande do Sul, Porto Alegre, and his associates reported in the International Journal of Infectious Diseases.
© Dr. A. Harrison; Dr. P. Feorino / CDC
The randomly selected participants were 208 well-controlled persons living with HIV (PLWH) – outpatients identified from the South Brazilian HIV Cohort unit – who were individually matched by age, sex, and ethnicity to HIV-negative control counterparts from the primary practice unit of the same hospital. The study group (median age, 57 years) consisted primarily of individuals who were white in origin (79%); 44.2% were women. Nearly all (98.1%) PLWH participants were on highly active antiretroviral therapy (HAART), with 88% having an undetectable viral load. A higher tendency for alcohol use (16% vs. 6%) and a lower mean body mass index (26 kg/m2 vs. 26-30 kg/m2) also were noted for the PLWH group, compared with the HIV-negative control group.
Individuals with multimorbidity had at least two chronic comorbid diseases including hypertension, diabetes mellitus, chronic kidney disease, bone disease, hepatic disease, or cardiovascular disease at the time of the study. Neoplastic disease also was included if reported previously or as a current condition. Results from the Poisson regression analysis used to identify multimorbidity-associated factors and potential confounders were stratified by age category (50-55, 56-60, 61-65, and older than 65).
Individuals with HIV had a significantly higher prevalence of multimorbidity than did HIV-negative controls (63% vs. 43%; P less than .001). Renal, hepatic, and bone diseases were the main sources of this difference. The overall median number of comorbidities of the PLWH individuals was two, which was double the median number observed in the HIV-negative controls. Furthermore, examination of the age-stratified data showed that the PLWH patients in the 50-60 age group had almost twice the burden of disease as the corresponding HIV-negative individuals. Similarity in prevalence of comorbidities was apparent when comparing the youngest PLWH age group (50-55) with their HIV-negative counterparts who were at least 10 years older, the investigators said.
Regression analysis failed to reveal a specific covariate risk factor associated with a higher prevalence of multimorbidity between the HIV and control groups. However, univariate analysis showed significant associations with age (15% per 5 years over 50 years old; P less than .001) and being HIV positive (prevalence ratio, 1.47; P less than .001). Further investigation found that duration of HIV infection and cART exposure time were significantly associated with multimorbidity, resulting in an adjusted model of age (P = .015), duration of HIV infection (P = .027), and time on cART (P = .015), they said.
Of the considered comorbidities, it was noted that between groups there was no significant difference in cardiovascular disease, which may be due to better awareness and care of this risk in HIV-positive patients. In contrast, there was an increased prevalence of HIV-associated bone and kidney disease consistent with the proposed mechanisms of long-term chronic HIV-induced inflammation and antiretroviral toxicities that have previously been implicated as risk factors for excess multimorbidity in aging HIV populations.
This study was designed to investigate the burden of noninfectious comorbidities associated with HIV and, by conducting it in southern Brazil, explore “the risk factors for the occurrence of multimorbidity in HIV-positive individuals in the developing world,” Dr. Maciel and his associates wrote.
The 63% prevalence of multimorbidity associated with HIV was high compared with other reports that ranged from 7% to 29%. This may in part be associated with the Brazilian socioeconomic status in comparison with high-income countries. The researchers also showed that PLWH individuals would develop similar age-related comorbidities as HIV-negative controls but 10 years earlier. Based on this and the high multimorbidity occurrence they had reported in this study, the investigators said that health care providers “must be ready to face the emerging epidemic of multimorbidity affecting people living with HIV in the developing world.”
The authors reported that they had no conflicts of interest.
SOURCE: Maciel RA et al. Int J Infect Dis. 2018 May;70:30-5. doi: 10.1016/j.ijid.2018.02.009.