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Rate of simultaneous non-HIV age-related illnesses triples in US HIV group.

Over the last decade the rate of 2 or more simultaneous non-HIV age-related conditions (like diabetes and cancer) tripled from 8.2% to 22.4% in a large US group of people in care for HIV infection. (1) The two non-HIV conditions that occurred together most often in this recent study were hypertension * (high blood pressure) and high cholesterol. The study focused on 6 age-related conditions: hypertension, diabetes, chronic kidney disease, high cholesterol, end-stage liver disease, and non-AIDS cancers.

People with HIV infection are living longer thanks to effective antiretroviral therapy. Like all aging people, those with HIV face common age-related conditions that need regular care. These conditions--like diabetes and non-AIDS cancers--may arise more often in people with than without HIV for several reasons. For example, smoking causes or contributes to many diseases and smoking rates are higher in people with HIV. (2)

Despite the growing threat of serious non-HIV illnesses in people with HIV, little is known about how rates of these conditions have changed over time, which conditions occur together often, and which conditions are more frequent in different subgroups. Because knowing the answers to such questions can help in the detection and treatment of non-HIV illnesses, US researchers conducted this study.

How the study worked. Researchers focused on US adults in care for HIV infection sometime in the period from January 2000 through December 2009. Everyone took antiretroviral therapy. The study aimed to see how many of these people had multimorbiditv, defined as 2 or more of the following age-related conditions:

* Hypertension (high blood pressure)

* Diabetes

* Chronic kidney disease

* High cholesterol

* End-stage liver disease

* Non-AIDS cancers

For each study participant, researchers determined sex (male or female), race or ethnicity, risk factor for acquiring HIV infection, region of residence, age, type of antiretroviral therapy, number of years on antiretroviral therapy, calendar year, HIV suppression, AIDS status, and CD4 count in each study year.

The investigators used a standard statistical method to determine the multimorbidity rate, that is, the rate at which study participants had 2 or more of the age-related conditions listed above. This kind of statistical analysis yields an adjusted prevalence ratio, which means that the analysis accounts for the potential impact of factors like age, sex, race, CD4 count, and viral load on chances that these age-related conditions will develop.

What the study found. The study involved 22,969 HIV-positive adults taking antiretroviral therapy in the United States. Follow-up time for the group stood at a median of 3.8 years. About 80% of study participants were men, about 50% white, and about 40% black. Median age rose from 38 in 2000 to 44 in 2009. Over the same years, median CD4 count climbed from 361 to 448, and the proportion of people with an undetectable viral load jumped from 41% to 63%. Across the 2000 2009 study period, the yearly rate of multimorbidity (having 2 or more of the listed non-HIV age-related conditions) almost tripled, from 8.2% in 2000 to 22.4% in 2009. As expected, the rate of having 2 or more non-HIV conditions rose with age (Figure 1). But even after the researchers accounted for aging of the study group and other factors, the rate of having 2 or more non-HIV conditions was 26% higher in 2004-2006 than in 2000-2003 and 31% higher in 2007-2009 than in 2000-2003.

Rates of 2 or more non-HIV conditions did not differ between men and women. But the rate was lower in blacks or Hispanics than whites and higher in people infected with HIV during sex between men and women than during sex between men.

Compared with people who had a normal body mass Index (3) (a measure of weight) of 18.5 to 24.9 kg/[m.sup.2], overweight people (25 to 29.9 kg/[m.sup.2]) had a 1.44-fold higher rate of multimorbidity, and obese people had a 2.11-fold higher rate (if they were 30 to 40 kg/[m.sup.2]) and 2.69-fold higher rate (if they were above 40 kg/ [m.sup.2]).

The most frequent non-HIV age-related conditions in both 2000 and 2009 were high cholesterol and hypertension. Diabetes was the third most frequent condition in 2000, but by 2009 chronic kidney disease had become the third most common condition. In 2009 the most frequent pairs of these conditions were hypertension-high cholesterol (8.9% of people), hypertension-chronic kidney disease (1.6%), and diabetes-high cholesterol (1.3%). The most frequent non-HIV threesomes were the same in 2000 and 2009: hypertension-diabetes-high cholesterol (2.5%), hypertension-chronic kidney disease-high cholesterol (1.6%), and hypertension-high cholesterol-cancer (0.6%) (Figure 2).

What the findings mean for you. This very large and long study of US adults taking antiretroviral therapy found that the rate of 2 or more simultaneous major non-HIV conditions almost tripled over the last decade. This study focused on 6 major age-related conditions: hypertension, diabetes, chronic kidney disease, high cholesterol, end-stage liver disease, and non-AIDS cancers. These conditions can often be prevented or controlled, sometimes with nondrug strategies like physical activity, weight control, diet, cutting salt intake, and quitting smoking. People with HIV should work closely with their providers to stay alert for possible development of these conditions and should work to prevent or control them.

Results of this study underline the importance of one health-promoting tactic-weight control. Like many medical studies, this one figured weight as body mass index: weight measured in kilograms divided by height measured in meters squared. You can calculate your body mass index using pounds and inches at the link provided at reference 3 below. This study found that people who were overweight or obese had higher rates of multiple non-AIDS conditions than people who had normal weight, regardless of other disease risk factors. Figure out your body mass index with the tool provided at reference 3. If you're overweight or obese, talk to your HIV provider to make a plan for weight control.

The 6 conditions and illnesses this study focused on arise more often as people age, regardless of whether they have HIV infection. In this study of almost 23,000 adults with HIV, the rate of having 2 or more of the 6 conditions rose sharply with each additional decade of age after age 40 (Figure 1). This strong impact of age held true regardless of other factors that affect rates of these 6 conditions. The older you get, the more you have to watch out for age-related conditions and illnesses, and the more you have to take steps to prevent them. But prevention works best when people adopt a healthy lifestyle at a young age.

The researchers who conducted this study pointed out that the 6 conditions they focused on are interrelated. For example, hypertension or high cholesterol may lead to diabetes or kidney disease. So preventing or controlling one condition can prevent others.


(1.) Wong C, Gange SJ, Moore RD, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clin Infect Dis. 2018;66:1230-1238.

(2.) Mdodo R, Frazier EL, Dube SR, et al. Cigarette smoking prevalence among adults with HIV compared with the general adult population in the United States: cross-sectional surveys. Ann Intern Med. 2015;162:335-344.

(3.) National Heart, Lung, and Blood Institute. Calculate your body mass index. You can calculate your BMI using pounds and inches at wt/BMI/bmicalc.htm

* Words in boldface are explained in the Technical Word List at the end of this issue.
Figure 1. A study of 22,969 US adults treated with antiretroviral
therapy linked older age to a higher rate of having 2 or more
non-HIV conditions like hypertension, high cholesterol, and
diabetes. The impact of older age held true regardless of
other factors included in this analysis.

Impact of age on rate of 2 or more
non-HIV conditions

40 to 49 y     34%
50 to 59 y     69%
60 or more y   95%

Compared with under 40 years

Note: Table made from bar graph.

Figure 2. In a study of US adults taking antiretroviral
therapy, the most frequent threesomes of non-HIV age-
related diseases always included hypertension and high

Most frequent non-HIV disease threesomes

Hypertension   Diabetes         High
                 Chronic        High
Hypertension     disease
Hypertension      High         Cancer
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Title Annotation:ARTICLE 1
Publication:HIV Treatment: ALERTS!
Geographic Code:1USA
Date:Dec 1, 2018
Previous Article:Technical Word List.
Next Article:Half of women with HIV and GYN cancer do not receive standard cancer therapy.

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