Ageing People Living With HIV Experience High Rates of Comorbidities
Presenter: Lene Ryom, MD, PhD, Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
A summary of Co-morbidities in People Living With HIV: Host- or HIV-Associated? from the session Growing Old With HIV: Co-morbidities and Ageing, presented July 18, 2021, at the 11th International AIDS Society (IAS) Conference on HIV Science.
As the population of people living with HIV (PLWH) grows older, patients will be affected by comorbidities associated with ageing. The burden of comorbidity increases with age; however, this may not be HIV-specific, and treating common risk factors of cardiovascular disease (CVD), for instance, may help mitigate comorbidities, according to Lene Ryom, MD, PhD, Centre of Excellence for Health, Immunity and Infections, Copenhagen, Denmark.
People with HIV carry a higher burden of comorbidities compared with lifestyle- and age-matched HIV-negative participants over age 45. These comorbidities range from CVD to other organ diseases, cancers, and mental health issues. Several comorbidities occur in disease clusters (eg, hypertension, diabetes, dyslipidemia, vascular and renal disease) more frequently together, suggesting an underlying pathogenesis.
“Factors associated with comorbidity in PLWH include HIV-related factors, the use of antiretroviral therapy (ART), and lifestyle factors," noted Ryom.
HIV-related factors include low CD4 count, immune and coagulation activation, inflammation, microbial translocation, viremia, opportunistic infections, and hepatitis C virus and hepatitis B virus. Treatment with ART can lead to adverse effects, polypharmacy and drug-drug interactions. Host lifestyle-related factors that can impact comorbidities include smoking, substance use, risk taking, education, financial issues, genetic predisposition, age, diet and exercise, obesity, and dyslipidemia.
“Risk factors may interact to manifest disease making it essential to have access to care, screening, and initiation of treatment,” said Ryom. “The more prevalent the risk factors, the more likely the PLWH is to develop incident disease.”
Smoking is one of the most important predictors of comorbidity and is highly prevalent in PWLH. “In general, 7 years of life are lost due to smoking alone, whereas the impact of most HIV-related factors seems to diminish over time,” said Ryom.
Smoking cessation has by far the greatest impact on subsequent development of CVD compared with lowering blood pressure or cholesterol implying “…that smoking cessation should be a top priority for management of comorbidities for PLWH,” said Ryom. Smoking, elevated cholesterol, or hypertension seem to impact most cases of myocardial infarction, whereas HIV-related factors have a comparatively small impact.
In the 1990s, PLWH had almost twice the risk of myocardial infarction than HIV-negative control subjects. However, after more intensive screening and treatment of CVD, these risk factors no longer make a difference in PLWH. “With access to optimal treatment, we can now change the narrative of increased prevalence of comorbidities, at least for CVD,” said Ryom.
“If a person is at high risk for other factors, such as diabetes or hypertension, the impact of immune suppression is much more compared to those who only have immune suppression as a risk factor. We need to see individual risk factors in the broader context of what other risk factors coexist,” said Ryom.
With increased complexity and the number of comorbidities and risk factors, it is important to have a systematic and multidisciplinary approach to risk factor identification and management. Guidelines such as those from the European AIDS Clinical Society are available online and are updated annually, she said.
In conclusion, Ryom noted that ageing PLWH continue to experience high rates of comorbidities, with lifestyle and host factors being key drivers. The impact of HIV-related factors and ART should not be overlooked though studies of CVD have shown that this may be overcome with access to optimal treatment.
Disclosures
Lene Ryom, MD, PhD, reported nothing to disclose.
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