We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Aging-Related Comorbidity Burden Among Women and Men With or At-Risk for HIV in the US, 2008-2019.
- Authors
Collins, Lauren F.; Palella Jr, Frank J.; Mehta, C. Christina; Holloway, JaNae; Stosor, Valentina; Lake, Jordan E.; Brown, Todd T.; Topper, Elizabeth F.; Naggie, Susanna; Anastos, Kathryn; Taylor, Tonya N.; Kassaye, Seble; French, Audrey L.; Adimora, Adaora A.; Fischl, Margaret A.; Kempf, Mirjam-Colette; Koletar, Susan L.; Tien, Phyllis C.; Ofotokun, Ighovwerha; Sheth, Anandi N.
- Abstract
Key Points: Question: Is HIV associated with aging-related comorbidity burden differentially among US women and men? Findings: In this cross-sectional study including 5926 US adults, the overall burden of 10 non-AIDS comorbidities after covariate adjustment was significantly higher in women vs men, particularly among persons with HIV, and comorbidity prevalence differed by sex. Meaning: Clinical guidance and tools for promoting healthy aging in HIV are urgently needed, and these results suggest that novel strategies developed for comorbidity screening and prevention in persons with HIV would ideally consider sex and gender differences in comorbidity risk and address social determinants of health. This cross-sectional study of US adults compares the burden of non-AIDS comorbidities between persons with HIV and those without by age and sex. Importance: Despite aging-related comorbidities representing a growing threat to quality-of-life and mortality among persons with HIV (PWH), clinical guidance for comorbidity screening and prevention is lacking. Understanding comorbidity distribution and severity by sex and gender is essential to informing guidelines for promoting healthy aging in adults with HIV. Objective: To assess the association of human immunodeficiency virus on the burden of aging-related comorbidities among US adults in the modern treatment era. Design, Setting, and Participants: This cross-sectional analysis included data from US multisite observational cohort studies of women (Women's Interagency HIV Study) and men (Multicenter AIDS Cohort Study) with HIV and sociodemographically comparable HIV-seronegative individuals. Participants were prospectively followed from 2008 for men and 2009 for women (when more than 80% of participants with HIV reported antiretroviral therapy use) through last observation up until March 2019, at which point outcomes were assessed. Data were analyzed from July 2020 to April 2021. Exposures: HIV, age, sex. Main Outcomes and Measures: Comorbidity burden (the number of total comorbidities out of 10 assessed) per participant; secondary outcomes included individual comorbidity prevalence. Linear regression assessed the association of HIV status, age, and sex with comorbidity burden. Results: A total of 5929 individuals were included (median [IQR] age, 54 [46-61] years; 3238 women [55%]; 2787 Black [47%], 1153 Hispanic or other [19%], 1989 White [34%]). Overall, unadjusted mean comorbidity burden was higher among women vs men (3.4 [2.1] vs 3.2 [1.8]; P =.02). Comorbidity prevalence differed by sex for hypertension (2188 of 3238 women [68%] vs 2026 of 2691 men [75%]), psychiatric illness (1771 women [55%] vs 1565 men [58%]), dyslipidemia (1312 women [41%] vs 1728 men [64%]), liver (1093 women [34%] vs 1032 men [38%]), bone disease (1364 women [42%] vs 512 men [19%]), lung disease (1245 women [38%] vs 259 men [10%]), diabetes (763 women [24%] vs 470 men [17%]), cardiovascular (493 women [15%] vs 407 men [15%]), kidney (444 women [14%] vs 404 men [15%]) disease, and cancer (219 women [7%] vs 321 men [12%]). In an unadjusted model, the estimated mean difference in comorbidity burden among women vs men was significantly greater in every age strata among PWH: age under 40 years, 0.33 (95% CI, 0.03-0.63); ages 40 to 49 years, 0.37 (95% CI, 0.12-0.61); ages 50 to 59 years, 0.38 (95% CI, 0.20-0.56); ages 60 to 69 years, 0.66 (95% CI, 0.42-0.90); ages 70 years and older, 0.62 (95% CI, 0.07-1.17). However, the difference between sexes varied by age strata among persons without HIV: age under 40 years, 0.52 (95% CI, 0.13 to 0.92); ages 40 to 49 years, −0.07 (95% CI, −0.45 to 0.31); ages 50 to 59 years, 0.88 (95% CI, 0.62 to 1.14); ages 60 to 69 years, 1.39 (95% CI, 1.06 to 1.72); ages 70 years and older, 0.33 (95% CI, −0.53 to 1.19) (P for interaction =.001). In the covariate-adjusted model, findings were slightly attenuated but retained statistical significance. Conclusions and Relevance: In this cross-sectional study, the overall burden of aging-related comorbidities was higher in women vs men, particularly among PWH, and the distribution of comorbidity prevalence differed by sex. Comorbidity screening and prevention strategies tailored by HIV serostatus and sex or gender may be needed.
- Subjects
UNITED States; THERAPEUTIC use of protease inhibitors; HIV infection complications; HIV infection risk factors; RESEARCH; HIV-positive persons; HIV infections; HYPERTENSION; BONE diseases; STATISTICS; CONFIDENCE intervals; SUBSTANCE abuse; CROSS-sectional method; AGE distribution; LUNG diseases; MULTIVARIATE analysis; ANTIRETROVIRAL agents; REGRESSION analysis; DIABETES; CARDIOVASCULAR diseases; MANN Whitney U Test; RACE; RISK assessment; SEX distribution; HYPERLIPIDEMIA; KIDNEY diseases; COMPARATIVE studies; AGING; RESEARCH funding; DESCRIPTIVE statistics; CHI-squared test; SOCIAL classes; STATISTICAL correlation; SOCIODEMOGRAPHIC factors; TUMORS; SMOKING; BODY mass index; DATA analysis software; COMORBIDITY; LONGITUDINAL method; MENTAL illness; DISEASE risk factors; ADULTS
- Publication
JAMA Network Open, 2023, Vol 6, Issue 8, pe2327584
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.27584