Lorraine L. Janeczko

March 13, 2013

Adults with HIV are substantially more likely to have cancer, to experience myocardial infarction (MI), and to have end-stage renal disease, but not at younger ages, according to a new study.

The findings, presented here at the 20th Conference on Retroviruses and Opportunistic Infections (CROI), contrast with previous studies suggesting that patients with HIV are diagnosed with age-related diseases at "dramatically" younger ages.

Dr. Keri Althoff

"HIV-infected adults had a 6-month decrease in mean age for HIV-associated and non-AIDS-defining cancers compared to HIV-uninfected adults after adjustment for confounders," lead investigator Keri Althoff, PhD, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, told Medscape Medical News. They also have similar age at the time of diagnosis of MI and end-stage renal disease, she said.

To investigate whether HIV-positive adults age prematurely, Dr. Althoff and her team studied the mean ages at which cancer, MI, and renal disease occurred in United States veterans.

The researchers looked at 31,454 HIV-positive participants of the Veterans Aging Cohort Study and matched them to 68,558 HIV-negative control individuals.

They found that the adjusted mean age at cancer diagnosis was slightly younger in HIV-positive veterans compared with HIV-negative veterans. There was a 37% increase in the risk for cancer by HIV status after adjustment.

The mean age at the time of MI was 55.3 years in veterans with and without HIV. There was an 81% increase in the risk for MI by HIV status after adjustment.

The mean age at time of diagnosis of end-stage renal disease was 55.3 years in HIV-positive patients compared with 58.3 years in those with no infection. The adjusted mean age at diagnosis was not statistically significantly different between groups, and there was a 55% increase in the risk for renal disease by HIV status.

Table. Risk for Age-Related Comorbidities

Patients Events Mean Age Adjusted Incidence 95% Confidence Interval
HIV-positive with HIV-associated cancer (n = 30,675) 579 54.9 1.84 1.62 - 2.09
HIV-negative with HIV-associated cancer (n = 66,991) 565 57.8 1.00 N/A
HIV-positive with MI (n = 27,988) 231 55.3 1.81 1.49 - 2.20
HIV-negative with MI (n = 56,456) 286 55.3 1.00 N/A
HIV-positive with end-stage renal disease (n = 31,139) 346 55.3 1.43 1.22 - 1.66
HIV-negative with end-stage renal disease (n = 68,113) 502 58.3 1.00 N/A

 

Dr. Althoff acknowledged that although the study's strengths include the appropriate comparison group, a sample size large enough to study these outcomes, and adjustment for important confounders, the mostly male patient population might not make the results applicable to women.

Also, she pointed out that the fact that dialysis-dependent acute renal failure was included in renal disease patient counts might have affected the data.

Still, Dr. Althoff said, "Our findings are good news, but it is important to note that only 10% of our study population was below the age of 40 years old."

Dr. Judith Currier

Judith Currier, MD, from the University of California, Los Angeles, also suggested to Medscape Medical News that studies of women are necessary. Dr. Currier, who was not involved in the study, pointed out that with such a small number of patients younger than 40 years, more work is needed to confirm whether HIV patients are aging prematurely.

This will "help us see whether there is an earlier occurrence of MI, renal disease, or cancer in HIV," said Dr. Currier, who says that she has not ruled out the findings of previous studies suggesting this is the case.

Dr. Trevor Crowell

Trevor Crowell, MD, from Johns Hopkins University School of Medicine in Baltimore, Maryland, said in an interview that he would like to know about the mechanisms of the increased risk for comorbidities. "This important study identifies very clearly that HIV-positive patients have increased risk of cardiovascular disease, cancer, and renal disease. The next question is, 'Why'?"

Dr. Crowell says he plans to apply these findings to patient care. "This study tells me, as a clinician, that I don't need to think that my 30-year-old HIV-positive patient has the risk of an older person from the general population. With our youngest patients, I can focus on other things before worrying about these issues as much," he added.

Dr. Althoff says she recommends screening and prevention. "The increased risk of these age-related diseases and cancer diagnoses occurring at slightly younger ages suggests the need for screening programs and greater prevention involving diet, exercise, smoking cessation, and diabetes control to protect the health of adults aging with HIV."

In her talk, Dr. Althoff mentioned a related study, also presented at CROI and reported by Medscape Medical News , that identified an increased risk for MI in patients with HIV.

Matthew Freiberg, MD, from the University of Pittsburgh in Pennsylvania, and his team found that HIV-positive adults are 50% more likely to have a heart attack than people without the infection.

This study was funded by the National Institute of Allergy and Infectious Diseases. Dr. Althoff, Dr. Judith Currier, and Dr. Trevor Crowell have reported no relevant financial relationships.

20th Conference on Retroviruses and Opportunistic Infections (CROI). Presented March 4, 2013.

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