Comorbidity prevalence was found to differ by sex, with the overall burden of aging-related comorbidities being higher in women compared with men, particularly those who are living with HIV (PWH). A new study published in JAMA Network Open claims that screening for comorbidities and tailoring prevention strategies should be informed by HIV serostatus and sex or gender.
PWH have had an increase in lifespan through antiretroviral therapy (ART), which had led to more than 50% of PWH in the United States being 50 years or older in 2019. Aging-related non-AIDS comorbidities (NACM) have been found to have sex differences in terms of risk and severity. Women living with HIV have had a higher prevalence of the burden from aging comorbidities compared with women not living with HIV. This study aimed to “assess the association of HIV and comorbidity burden by sex.”
The Multicenter AIDS Cohort Study and the Women’s Interagency HIV Study were used for analyzing data. All patients in these cohorts had semiannual visits where sociodemographic, medical history and behaviors, medication use, physical examinations, and biospecimens were collected.
The study was cross-sectional and focused on PWH and HIV-seronegative participants with 2 or more study visits since 2009 for the Women’s Interagency HIV Study and 2008 for the Multicenter AIDS Cohort Study. There were 10 NACM evaluated: hypertension, dyslipidemia, diabetes, cardiovascular disease, kidney disease, liver disease, lung disease, bone disease, psychiatric illness, and non-AIDS cancer. The secondary outcome was the prevalence of each NACM.
There were 5929 participants included in the study, of which 47% identified as Black, 19% identified as Hispanic or other, and 34% identified as White; the median (IQR) age of the participants was 54 (46-61) years. Fifty-five percent of the participants were women (n = 2316; 922 HIV seronegative). The median observation was 16.1 (5.0-18.2) years for women and 25.5 (15.3-34.1) years for men.
Increasing age categories were found to be associated with a higher mean (SD) NACM burden, with those younger than 40 years having a mean of 1.49 (1.32); those aged 40 to 49 years, 2.58 (1.72); those aged 50 to 59 years, 3.63 (1.80); those aged 60 to 69 years, 4.21 (1.81; and those 70 years and older, 4.41 (1.73).
PWH had a higher mean NACM burden overall and in every age category compared with those not living with HIV (3.47 [1.99] vs 3.03 [1.86]). Women also had a higher mean burden of NACM compared with men (3.36 [2.08] vs 3.24 [1.79]). However these differences were not statistically significant in PWH or individuals who did not have HIV.
Women had a higher prevalence of bone disease (42% vs 19%), lung disease (38% vs 10%), and diabetes (24% vs 17%) compared with men. However, they had a lower prevalence of hypertension (68% vs 75%), psychiatric illness (55% vs 58%), dyslipidemia (41% vs 64%), liver disease (34% vs 38%), and non-AIDS cancer (7% vs 12%).
The estimated mean difference of the burden of NACM was greater in women vs men in every age category in PWH. There was an estimated mean difference between women and men in individuals younger than 40 years of 0.33 (95% CI, 0.03-0.63); those aged 40 to 49 years, 0.37 (95% CI, 012-0.61; those aged 50 to 59 years, 0.38 (95% CI, 0.20-0.56); those aged 60 to 69 years, 0.66 (95% CI, 0.42-0.90); and those 70 years and older, 0.62 (95% CI, 0.07-1.17).
There were some limitations to this study. The differences in characteristics of the participants and the risk of NACM by sex could have been due to recruitment or enrollment criteria. In addition, the sample may not be wholly representative of the PWH population in the United States. Time-varying covariates could not be accounted for, and self-reported medication was relied upon for some data sources, which is subject to bias.
The researchers concluded that their research “highlight[ed] PWH as an aging population at unique risk of multimorbidity with women disproportionally affected.” Accurately identifying the PWH who are at risk of multimorbidity is crucial to offering timely risk-modification interventions.
Collins LF, Palella FJ, Mehta CC, et al. Aging-related comorbidity burden among women and men with or at-risk for HIV in the US, 2008-2019. JAMA Netw Open. 2023;6(8):e2327584. doi:10.1001/jamanetworkopen.2023.27584