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CROI 2013: HIV+ Men at Increased Risk for Co-morbid Conditions Regardless of Age

 Men with HIV in a large cohort of U.S. veterans were more likely to develop cardiovascular disease, end-stage kidney disease, and certain cancers compared with HIV negative people, but not at earlier ages, according to a report presented at the 20th Conference on Retroviruses and Opportunistic Infections this month in Atlanta.

A sub-analysis from the Veteran's Aging Cohort Study (VACS) evaluated myocardial infarction (MI) or heart attacks, end-stage renal disease (ESRD), and cancers among HIV positive individuals and HIV negative people of similar or older age. The main finding from was that there were higher risks for the 3 co-morbid conditions depending on the type of statistical methods employed, but that there were no significant age differences in when they occurred.

VACS is a prospective, observational cohort of HIV positive people and an control group of HIV negative veterans matched for age, race, and site in the Veterans Administration system of care. The study's aim was to understand the role of comorbid medical and psychiatric disease in clinical outcomes in HIV infection.

Keri Althoff from the VA Medical Center andGeorge Washington University Medical Center presented findings from a sub-analysis covering the period October 2003 through September 2008 and including over 100,012 participants. Most were men, three-quarters were between 40 and 59 years of age, and 48% were black.

Results

Heart Disease

• Considering a mean age of 55.3 years, there was no difference in the number of heart attacks between HIV positive participants and HIV negative individuals.
• However, when looking at the overall person-year risk, there was a striking 81% increase in MI rate compared with HIV negative adults after adjustment for confounders.
• There was no difference in the mean age at the time of MI according to HIV status.
• Age-stratified crude incidence rates of MI were not significantly different regardless of HIV status.

Kidney Disease

• There also was no overall difference in ESRD with regard to mean age and HIV status, but HIV positive adults had a 43% increase in ESRD after adjustment for confounders.
• There was no significant difference in mean age to develop ESRD by HIV status.
• The age-stratified crude incidence rates of ESRD was slightly higher for HIV positive people compared with HIV negative adults across all age categories.

Cancer

• Looking at cancer, there was a significant difference in the rate of HIV-associated cancers, but not other types of cancer: an increase of 84% after adjustment for confounders.
• There was about a 2.9 year mean age difference, or a 7-month decrease in age at the time of diagnosis of an HIV-associated malignancy. 
• Age-stratified crude incidence rates of HIV-related cancers were consistently higher for HIV positive adults in all age categories.
• The crude difference in age at diagnosis of HIV-related cancers was 3.2 years, but the adjusted mean difference in age was only -0.23 years.
• There was no difference in the rate of other (non-AIDS) cancers among HIV positive compared with HIV negative adults adults after adjustment for confounders.
• There was a 5 month decrease in the mean age at diagnosis of non-AIDS cancers in HIV positive vs negative adults.

The authors acknowledged a few limitations in the study. Since the cohort includes mostly men, the interpretation of these results are not generalizable to women with HIV.

After the presentation several researchers in the audience questioned why biomarkers were not assessed, which may have confirmed co-morbid conditions at even earlier ages.

3/20/13

Reference

K Althoff, C Wyatt, C Gibert, et al. HIV+ Adults Are at Greater Risk for Myocardial Infarction, Non-AIDS Cancer, and End-stage Renal Disease, but Events Occur at Similar Ages Compared to HIV^– Adults. 20th Conference on Retroviruses and Opportunistic Infections (CROI 2013). Atlanta, March 3-6, 2013. Abstract 59.