Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

Objectives As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HI...

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Autores principales:	Taylor McLinden, Julio S G Montaner, Robert S Hogg, Ni Gusti Ayu Nanditha, Adrianna Paiero, Hiwot M Tafessu, Martin St-Jean, Jacek Kopec, Viviane D Lima
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/c9e0e7950c9f4da3a3f3220757bee0c8
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spelling	oai:doaj.org-article:c9e0e7950c9f4da3a3f3220757bee0c82021-11-18T15:30:04ZExcess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study10.1136/bmjopen-2020-0417342044-6055https://doaj.org/article/c9e0e7950c9f4da3a3f3220757bee0c82021-01-01T00:00:00Zhttps://bmjopen.bmj.com/content/11/1/e041734.fullhttps://doaj.org/toc/2044-6055Objectives As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and setting This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.Participants The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measures The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.Results Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.Conclusions PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.Taylor McLindenJulio S G MontanerRobert S HoggNi Gusti Ayu NandithaAdrianna PaieroHiwot M TafessuMartin St-JeanJacek KopecViviane D LimaBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 11, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Taylor McLinden Julio S G Montaner Robert S Hogg Ni Gusti Ayu Nanditha Adrianna Paiero Hiwot M Tafessu Martin St-Jean Jacek Kopec Viviane D Lima Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
description	Objectives As people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and setting This population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.Participants The study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measures The presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.Results Across study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.Conclusions PLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.
format	article
author	Taylor McLinden Julio S G Montaner Robert S Hogg Ni Gusti Ayu Nanditha Adrianna Paiero Hiwot M Tafessu Martin St-Jean Jacek Kopec Viviane D Lima
author_facet	Taylor McLinden Julio S G Montaner Robert S Hogg Ni Gusti Ayu Nanditha Adrianna Paiero Hiwot M Tafessu Martin St-Jean Jacek Kopec Viviane D Lima
author_sort	Taylor McLinden
title	Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
title_short	Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
title_full	Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
title_fullStr	Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
title_full_unstemmed	Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study
title_sort	excess burden of age-associated comorbidities among people living with hiv in british columbia, canada: a population-based cohort study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/c9e0e7950c9f4da3a3f3220757bee0c8
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Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

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