Evolution of comorbidities in people living with HIV between 2004 and 2014: Cross-sectional analyses from ANRS CO3 Aquitaine Cohort

Abstract

Objective The objective of the present study was to describe the evolution of chronic non-AIDS related diseases and their risk factors, in patients living with HIV (PLHIV) included in the French ANRS CO3 Aquitaine prospective cohort, observed both in 2004 and in 2014 in order to improve long-term healthcare management. Patients and Methods The ANRS CO3 Aquitaine cohort prospectively collects epidemiological, clinical, biological and therapeutic data on PLHIV in the French Aquitaine region. Two cross sectional analyses were performed in 2004 and 2014, regarding patient characteristics, HIVRNA and CD4 counts and prevalence of some of the common comorbidities and treatment. Results 2,138 PLHIV (71% male, median age 52.2 years in 2014), who had at least one visit registered in the cohort both in 2004 and 2014 were included in the study. We have observed a significant increase in the prevalence of diagnosed chronic kidney disease (CKD), bone fractures, cardiovascular events (CVE), hypertension, diabetes and dyslipidaemia as well as an increase in treatment or prevention for these conditions (statins, clopidogrel, aspirin). This is also reflected in an increase in the proportion of patients in the high or very high risk groups in the different disease risk scores for CKD, CVE and bone fracture score. Conclusions Between 2004 and 2014, the population aged and experienced an overall higher prevalence of non-HIV related comorbidities, including CKD and CVD. Careful HIV management according to current recommendations, and optimal selection of antiretrovirals, in addition to a good control of risk factors for these comorbidities, through lifestyle improvements and preventative measures, could lead to an early management of these comorbidities and to a continuous improvement of PLHIV health status.

Corticosteroids Use and Incidence of Severe Infections in People Living with HIV Compared to a Matched Population

“…Several lines of evidence have suggested that PLWH use corticosteroids at a higher rate than the general population, due to their comorbidities and autoimmune disorders. 13,24,25 It has been shown that clinicians avoid prescribing corticosteroids to PLWH out of concern for adverse outcomes. 26 Drug-drug interactions between HAART and corticosteroids or other medications can explain the increased risk of severe infections in PLWH.…”

“…9,31 A literature review of cases reports on systemic erythematous lupus (SLE) and HIV included 55 PLWH with SLE. The median age was 32 years old [23][24][25][26][27][28][29] and median CD4 count of 353/mm 3 [214-560.] Fifty-three patients received treatment for SLE of which 52.2% were administered corticosteroids.…”

A new era of HIV care for age-associated multimorbidity

“…Although NCD and multimorbidity accumulate with older age among PWH [12,15], this doesn't appear to be a legacy effect from pre-ART era AIDS related disease as risk is not associated with the calendar period of HIV diagnosis [12]. Indeed, NCDs may be accruing early in life as the differences compared to HIV negative individuals are more pronounced in younger PWH; in the WHIS cohort, women <25 years old had the greatest NCD incidence rate ratio [7] and in the UK hazard ratios for hypertension (HTN), chronic kidney disease (CKD) and ischaemic heart disease (IHD) are higher in PWH under, rather than over, 40 years old [9].…”

“…However, HIV specialists have found themselves widening their scope of care provision, while the HIV focused model has rarely changed. For example, a recent cross-sectional analysis from France found a significant increase in use of NCD preventive medication (statins, clopidogrel, aspirin) in PWH [15]. The potential deficiency of the single disease model of HIV care was strikingly illustrated by a 20-year analysis of the Multicentre AIDS Cohort Study cohort that found risk for incident DM in men with prediabetes was 40% (95% confidence interval [CI]: 0–80%) higher among PWH after adjusting for competing risk factors [20].…”