April 05, 2020
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Women living with HIV have greater burden of non-AIDS comorbidities

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Ighovwerha Ofotokun

Women with HIV experience an overall greater burden of non-AIDS comorbidities than HIV-seronegative women, according to findings published in Clinical Infectious Diseases.

“Among persons living with HIV (PLWH) treated with combination antiretroviral therapy, age-associated non-AIDS comorbidities (NACM) increasingly account for morbidity and mortality. Prior cohort studies describing the epidemiology of NACM among PLWH, however, severely lacked adequate representation of female participants and did not necessarily present findings in a sex-stratified fashion,” Ighovwerha Ofotokun, MD, MSc, professor of medicine in the division of infectious diseases at Emory University School of Medicine, told Healio. “Given that biologic and sociobehavioral factors influencing comorbidity development likely differ by sex, we wanted to evaluate the NACM prevalence and burden among women specifically.”

To do so, Ofotokun and colleagues analyzed data from the Women’s Interagency HIV Study (WIHS), a nationally representative cohort of women living with HIV infection (WLWH) and at-risk HIV-seronegative women. The researchers assessed 2,309 virologically-suppressed WLWH and 923 HIV-seronegative participants in the WIHS. The median age of participants was 50 years; 65% of women were black and 70% had ever used cigarettes.

Covariates, as well as the number of NACM and related prevalence, were summarized at the most recent WIHS visit. The researchers also examined burden of NACM according to HIV serostatus and age. The median observation period was 15.3 years.

Overall, researchers found that total NACM were significantly higher among WLWH compared with HIV-seronegative women (3.6 vs 3; P < .0001). Of the NACM observed in the study, psychiatric illness, dyslipidemia, non-AIDS-defining cancer and kidney, liver and bone disease were higher among WLWH (all P < .01).

NACM occur up to a decade earlier in PLWH compared with HIV-seronegative counterparts, according to Ofotokun. Routine health screening tools — such as those used for cardiovascular disease and bone fracture risk — are not performed as often in PLWH. Comparing the findings in this study with data from other multisite U.S. cohorts that look at multimorbidity suggests the NACM burden may be greater among WLWH than among men with HIV, he continued.

The researchers hope that additional studies provide greater insight into the accumulation of comorbidities that may guide HIV-specific, sex-delineated clinical guidance about screening patients with HIV for comorbidities, as well as management and prevention, according to Ofotokun.

“Findings from our study and others underscore the importance of emphasizing screening and intervention based on social determinants of health and modifiable lifestyle factors to mitigate comorbidity risk in aging WLWH,” he told Healio.

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In an accompanying commentary, Moises A. Huaman, MD, MSc, and Carl J. Fichtenbaum, MD, of the division of infectious diseases at the University of Cincinnati, wrote that further research is necessary to determine the biological mechanisms and environmental and sociobehavioral determinants of increased non-AIDS comorbidities in WLWH. The data presented in the study from Ofotokun and colleagues provide “a compelling rationale” for implementing and testing interventions that reduce the impact of known risk factors for comorbidities among WLWH.

“These data should motivate various agencies and organizations to dedicate additional funding to allow researchers to continue to unravel these mysteries, with the aim of helping to alleviate suffering for those afflicted by a chronic disease without a cure,” Huaman and Fichtenbaum wrote. – by Caitlyn Stulpin

Disclosures: Fichtenbaum reports receiving grants from Amgen, Cytodyn, Gilead Sciences, Janssen, Merck and ViiV Healthcare and personal fees from Clinical Care Options outside the submitted work. Huaman and Ofotokun report no relevant financial disclosures. Please see the full studies for all other authors’ relevant financial disclosures.