Abstract and Introduction
As HIV-infected patients live longer, more are developing chronic diseases typical of aging — but they appear to be doing so earlier and at a higher rate than the general population.
Since the advent of potent antiretroviral therapy (ART), the primary causes of morbidity and mortality among HIV-infected patients have shifted from AIDS-related illnesses to the chronic noncommunicable conditions typically associated with aging. Two research groups recently described the epidemiology of these conditions in HIV-infected patients.
Guaraldi and colleagues evaluated the prevalence of noninfectious comorbidities among 2854 HIV-infected patients receiving ART in Italy (mean age, 46; 71% with undetectable viral loads; median duration of infection, 16 years; median nadir CD4 count, 170 cells/mm3; median current CD4 count, 520 cells/mm3) and 8562 HIV-uninfected controls matched for age and sex. Compared with the controls, the HIV-infected patients had a higher prevalence of renal failure, bone fracture, and diabetes in every age range evaluated (≤40, 41–50, 51–60, and >60), as well as a higher prevalence of cardiovascular disease and hypertension at ages ≤60. They were also more likely, across all age strata, to have at least two of these conditions simultaneously (which the authors describe as "polypathology"). Of note, the HIV-infected patients appeared to develop polypathology at a younger age than controls, such that a 40-year-old HIV-infected patient had a risk similar to that of a 55-year-old HIV-uninfected person. Among HIV-infected patients, polypathology was significantly associated with increasing age, male gender, nadir CD4 count <200 cells/mm3, lipoatrophy, and lipohypertrophy.
In a separate study, Hasse and colleagues evaluated the incidence of AIDS-related and non–AIDS-related events among 8444 patients who were followed in the Swiss HIV Cohort Study between 2008 and 2010 (median age, 45; median nadir CD4 count, 190 cells/mm3; median current CD4 count, 528 cells/mm3). Approximately 30% of study participants were female, 23% had a prior AIDS diagnosis, and 69% had undetectable viral loads. During follow-up, there were 100 new AIDS-related events in the cohort versus 994 new non-AIDS events, including 39 strokes, 55 myocardial infarctions, 70 cases of diabetes, 115 non–AIDS-defining malignancies, and 160 fractures. Each of these non-AIDS conditions was significantly more common after age 50, even after adjustment for factors related to HIV disease progression and the development of comorbidities.
AIDS Clinical Care © 2011 Massachusetts Medical Society