Identifying the appropriate comparison group for HIV-infected individuals

Abstract

Purpose of Review HIV-infected individuals are living longer as a result of effective treatment. Age-related comorbidities now account for the majority of morbidity and mortality among treated HIV-infected adults. Previous findings regarding the age at, and risk of, these comorbidities have been mixed, sparking debate in the field. Discerning potential differences in the occurrence and burden of age-related comorbidities among treated HIV-infected adults as compared with uninfected adults of the same age requires careful selection of the appropriate uninfected comparison group. Recent Findings The validity of comparisons to HIV-uninfected populations is threatened when differences in demographic, clinical, and lifestyle characteristics between HIV-infected and uninfected adults are not considered. Identifying a pool of HIV-uninfected individuals from existing secondary data resources and employing selection methodologies may be a novel approach to reduce threats to internal validity. Issues related to identifying data sources, understanding inclusion criteria, determining measurement error, and threats to inference are discussed. Summary The development of clinical interventions targeting age-related comorbidities will rely on deriving valid inferences from appropriate comparison groups. The use of secondary data resources and selection methodology to create the appropriate uninfected comparison group is an attractive approach in the setting of finite resources, but are not without limitations.

Excess Clinical Comorbidity Among HIV-Infected Patients Accessing Primary Care in US Community Health Centers

“…11 Almost all studies assessing HIV morbidity have used samples of patients from specialty clinics at teaching hospitals, rather than community-based samples, raising questions about generalizability of the findings. 12 To date, no studies of chronic HIV infection have been conducted in safety-net community health centers in the United States, where disenfranchised patients may have multiple risk factors for other common conditions. Studies of HIV-infected patients in the Veterans Administration system have provided important insights about the changing spectrum of HIV disease in a racially and ethnically diverse sample but may not be generalizable to community-based samples.…”

“…11 Almost all studies assessing HIV morbidity have used samples of patients from specialty clinics at teaching hospitals, rather than community-based samples, raising questions about generalizability of the findings. 12…”

Elevated Markers of Vascular Remodeling and Arterial Stiffness Are Associated With Neurocognitive Function in Older HIV+ Adults on Suppressive Antiretroviral Therapy

“…Discerning differences in PP among HIV+ adults on suppressive cART as compared with HIV- adults requires careful selection of the appropriate HIV- comparison group. 53 Our HIV+ and HIV- samples were largely comparable across many characteristics (e.g., age and prevalence of medical comorbidities and lifetime substance use disorders). Thus, our failure to detect differences in PP may indicate that HIV+ persons do not have greater arterial stiffening when compared to an HIV- sample with a comparable prevalence of comorbidities.…”

Accounting for HIV Health Disparities: Risk and Protective Factors Among Older Gay and Bisexual Men

“…In addition, our findings also reinforce that older adults of color are overrepresented among people over the age of 50 living with HIV infection (CDC, 2018c), suggesting the intersectionality of race/ethnicity, sexual orientation, and HIV status. These findings are important as many of the methodological concerns expressed in previous HIV research have been addressed in this study including small sample size, particularly among racial and ethnic minorities, and lack of a demographically similar HIV uninfected comparison group (Goulet et al, 2007;Wong et al, 2014). The second research question this analysis sought to assess was which health risk and promoting factors account for the disparities in poor general health and depressive symptomatology between gay and bisexual older men living with HIV and without HIV infection.…”

“…Similarly, using non HIV-infected individuals from the general population creates other problems. Uninfected adults from the general population are different from persons living with HIV, and demographic, lifestyle, socioeconomic factors, and health outcomes (including comorbidities) must be considered (Wong, Althoff, & Gange, 2014). Sample size is also a concern, as even studies using a nationally representative sample most often have a small number of older adults living with HIV (Beatie, Mackinzie, & Chou, 2015).…”