Non-AIDS-related Comorbidities among People Living with HIV Aged 50 Years and Older: A Cross-sectional Study at Hua Hin Hospital, 2018-2019
DOI:
https://doi.org/10.59096/osir.v13i4.262788Keywords:
HIV, PLHIV, comorbidity, elderly, ThailandAbstract
With the success of combination antiretroviral therapy (cART), HIV-infected individuals are living longer and, as a consequence, are experiencing an increasing number of and more varied age-related comorbidities. Nevertheless, there are limited data regarding the profile of these chronic comorbidities among aging people living with HIV in Thailand. We therefore aimed to determine the prevalence and risk factors of non-AIDS related comorbidities in this population. A cross-sectional study was conducted utilizing an electronic medical record database from the HIV clinic at Hua Hin Hospital. We assessed the prevalence of chronic comorbidities among HIV patients aged at least 50 years. Multivariate logistic regression analysis was performed to identify factors associated with multimorbidity. Among 307 HIV patients, nearly half (49.2%) had at least 1 comorbidity and multimorbidity was present in 22.5% of the patients. The most common comorbidities were dyslipidemia (33.9%), hypertension (21.5%) and diabetes (8.1%). Age (OR 1.11, 95% CI 1.06-1.18), duration of HIV infection (OR 1.11, 95% CI 1.04-1.19), body mass index (OR 1.10, 95% CI 1.02-1.19) and stavudine-containing regimens (OR 2.63, 95% CI 1.46-5.90) were associated with multimorbidity. The finding underscores a significant burden of non-AIDS-related comorbidities in aging HIV patients. Given the complexity of clinical care in this population, a comprehensive multidisciplinary approach is of paramount importance to optimize overall health outcomes.
References
UNAIDS. Global HIV & AIDS statistics — 2019 fact sheet [Internet]. 2019 [cited 2020 Apr 1]. <https://www.unaids.org/en/resources/fact-sheet>
May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, et al. Impact on life expectancy of HIV-1 positive individuals of CD4+ cell count and viral load response to antiretroviral therapy. AIDS. 2014 May 15;28(8):1193-202.
UNAIDS. UNAIDS/PCB (39)/16.26 Agenda 11 thematic segment: HIV and ageing. 39th meeting of the UNAIDS PCB; 2016 Dec 8; Geneva, Switzerland. Geneva: UNAIDS; 2016 Nov 22.
Autenrieth CS, Beck EJ, Stelzle D, Mallouris C, Mahy M, Ghys P. Global and regional trends of people living with HIV aged 50 and over: estimates and projections for 2000-2020. PloS one 2018 Nov 29;13(11): e0207005-e.
Wing EJ. HIV and aging. Int J Infect Dis. 2016 Dec; 53:61-8.
Patel P, Rose CE, Collins PY, Nuche-Berenguer B, Sahasrabuddhe VV, Peprah E, et al. Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis. AIDS. 2018 Jul 1;32 Suppl 1(Suppl 1): S5-S20.
Bijker R, Choi JY, Ditangco R, Kiertiburanakul S, Lee MP, Siwamogsatham S, et al. Cardiovascular Disease and cardiovascular disease risk in HIV-positive populations in the Asian region. Open AIDS J. 2017 Aug 21; 11:52-66.
Schouten J, Wit FW, Stolte IG, Kootstra NA, van der Valk M, Geerlings SE, et al. Cross-sectional comparison of the prevalence of age-associated comorbidities and their risk factors between HIV-infected and uninfected individuals: the AGEhIV cohort study. Clin Infect Dis 2014 Dec 15;59(12):1787-97.
Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011 Dec;53(11):1120-6.
AVERT. HIV and AIDS in Thailand [Internet]. 2020 [cited 2020 Apr 1]. <https://www.avert.org/professionals/hiv-around-world/asia-pacific/thailand>
UNAIDS. Thailand: 2018 country factsheet [Internet]. 2018 [cited 2020 Mar 20]. <https://www.unaids.org/en/regionscountries/countries/thailand>
Kiertiburanakul S, Luengroongroj P, Sungkanuparph S. Clinical characteristics of HIV-infected patients who survive after the diagnosis of HIV infection for more than 10 years in a resource-limited setting. J Int Assoc Physicians AIDS Care (Chic). 2012 Nov-Dec;11(6):361-5.
Riyaten P, Salvadori N, Traisathit P, Ngo-Giang-Huong N, Cressey TR, Leenasirimakul P, et al. New-onset diabetes and antiretroviral treatments in HIV-infected adults in Thailand. J Acquir Immune Defic Syndr. 2015 Aug 1;69(4):453-9.
Jantarapakde J, Phanuphak N, Chaturawit C, Pengnonyang S, Mathajittiphan P, Takamtha P, et al. Prevalence of metabolic syndrome among antiretroviral-naive and antiretroviral-experienced HIV-1 infected Thai adults. AIDS Patient Care STDs 2014 Jul;28(7):331-40.
Nakaranurack C, Manosuthi W. Prevalence of non-AIDS comorbidities and factors associated with metabolic complications among HIV-infected patients at a Thai R referral hospital. J Int Assoc Provid AIDS Care. 2018 Jan-Dec; 17:2325957417752256.
Bureau of registration administration, Ministry of Interior, Thailand. Official statistics registration system [Internet]. 2019 [cited 2020 Apr 1]. <http://www.bora.dopa.go.th/index.php/th/>
Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med. 2012 Mar-Apr;10(2):142-51.
Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012 Sep;65(9):989-95.
Morris TP, White IR, Royston P. Tuning multiple imputation by predictive mean matching and local residual draws. BMC Med Res Methodol. 2014 Jun 5;14(1):75.
Nguyen CD, Carlin JB, Lee KJ. Model checking in multiple imputation: an overview and case study. Emerg Themes Epidemiol. 2017 Aug 23;14(1):8.
R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2020.
Ongwandee S, Kiertburanakul S, Avihingsanon A, Sukkul A, Lolekha R, editors. Thailand national guidelines on HIV/AIDS treatment and prevention 2017. Bangkok: The Agricultural Co-operative Federation of Thailand; 2017.
Ruzicka DJ, Imai K, Takahashi K, Naito T. Comorbidities and the use of comedications in people living with HIV on antiretroviral therapy in Japan: a cross-sectional study using a hospital claims database. BMJ Open. 2018 Jun 14;8(6): e019985.
Wu PY, Chen MY, Hsieh SM, Sun HY, Tsai MS, Lee KY, et al. Comorbidities among the HIV-infected patients aged 40 years or older in Taiwan. PloS One. 2014 Aug 13;9(8): e104945.
Serrão R, Piñero C, Velez J, Coutinho D, Maltez F, Lino S, et al. Non-AIDS-related comorbidities in people living with HIV-1 aged 50 years and older: The AGING POSITIVE study. Int J Infect Dis. 2019 Feb;79:94-100.
Maciel RA, Klück HM, Durand M, Sprinz E. Comorbidity is more common and occurs earlier in persons living with HIV than in HIV-uninfected matched controls, aged 50 years and older: A cross-sectional study. Int J Infect Dis. 2018 May;70:30-5.
Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A, et al. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med. 2017 Nov;18(10):724-35.
Wong C, Gange SJ, Moore RD, Justice AC, Buchacz K, Abraham AG, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clin Infect Dis. 2018 Apr 15;66(8):1230-8.
Do TC, Boettiger D, Law M, Pujari S, Zhang F, Chaiwarith R, et al. Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort. HIV Med. 2016 Aug;17(7):542-9.
Aekplakorn W, editor. The fifth Thai national health examination survey 2014. 1st ed. Nonthaburi (Thailand): Health System Research Institute;2016.
Ruzicka DJ, Imai K, Takahashi K, Naito T. Greater burden of chronic comorbidities and co-medications among people living with HIV versus people without HIV in Japan: a hospital claims database study. J Infect Chemother. 2019 Feb;25(2):89-95.
Becofsky KM, Wing EJ, Wing RR, Richards KE, Gillani FS. Obesity prevalence and related risk of comorbidities among HIV+ patients attending a New England ambulatory centre. Obes Sci Pract. 2016 Jun;2(2):123-7.
Obry-Roguet V, Brégigeon S, Cano CE, Lions C, Zaegel-Faucher O, Laroche H, et al. Risk factors associated with overweight and obesity in HIV-infected people: aging, behavioral factors but not cART in a cross-sectional study. Medicine (Baltimore). 2018 Jun;97(23): e10956.
Hidalgo JA, Florez A, Agurto C, Pinedo Y, Ayarza R, Rodriguez L, et al. Metabolic and cardiovascular comorbidities among clinically stable HIV patients on long-term ARV therapy in five ambulatory clinics in Lima-Callao, Peru. Open AIDS J. 2018 Oct 17;12:126-35.
D:A:D Study Group, Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, et al. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet. 2008 Apr 26;371(9622):1417-26.
Feeney ER, Mallon PWG. HIV and HAART-associated dyslipidemia. Open Cardiovasc Med J. 2011;5:49-63.
Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res. 2017 May;183:41-56.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
