Non-AIDS comorbidities more common among women with HIV
Non-AIDS comorbidities are more common among women living with HIV than in HIV-seronegative women, with the most dramatic difference occurring among women aged younger than 25 years, according to a study.
In the age of combination ART, as the life expectancy of people with HIV (PWH) approaches that of the general population, age-related non-AIDS comorbidities (NACM) like cardiovascular, kidney, liver and bone disease increasingly account for morbidity and mortality among this population, said Ighovwerha Ofotokun, MD, MSc, professor of medicine in the division of infectious diseases at Emory University School of Medicine.
“Women with HIV are historically underrepresented in clinical cohorts of PWH examining the burden of multimorbidity,” Ofotokun told Healio. “Leveraging the Women’s Interagency HIV Study (WIHS), we recently showed in a cross-sectional analysis that the burden of prevalent NACM was higher among women with HIV than women without HIV overall and in certain age groups.”
Ofotokun, along with Lauren F. Collins, MD, and colleagues assessed the effects of HIV serostatus and age on incident NACM burden among WIHS participants to better understand the longitudinal effects of chronic HIV among aging women. According to the study, women living with HIV (WLWH) and HIV-seronegative participants followed in the WIHS through and after 2009 — when more than 80% of WLWH used ART — were included in the study, with outcomes recorded through March 3, 2018.
Overall, there were 3,129 participants in the study 2,239 WLWH and 890 HIV-seronegative women with 36,589 person-years of follow-up. In fully adjusted analyses, the study demonstrated that WLWH had a higher incident NACM rate compared with HIV-seronegative women (incidence rate ratio [IRR] = 1.36, 95% CI, 1.02-1.81). Additionally, the incident NACM burden was higher among WLWH compared with HIV-seronegative women in most age strata, and women aged younger than 25 years had the greatest IRR by HIV serostatus at 1.48 (95% CI, 1.19-1.84) compared with those in older age groups.
The researcher said that incident NACM burden was associated with traditional comorbidity risk factors but not HIV-specific indices.
“The clinical take-home message is that the rate of NACM accrual was high for all women in the cohort, though higher for women with HIV, and began in the third decade of life,” Ofotokun said. “These findings support the need for earlier, more aggressive NACM screening and prevention for young women with HIV and at-risk women that could be integrated into a broader women’s health agenda during reproductive age. Innovative HIV- and female-specific comorbidity risk-assessment and risk-reducing tools are needed to mitigate the burden of incident NACM in this high-risk population, including focused attention to addressing social determinants of health.”