XIX International AIDS Conference


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THAB0205 - Oral Abstract

Comorbidity and ageing in HIV-1 infection: the AGEhIV Cohort Study

Presented by Judith Schouten (Netherlands).

J. Schouten1,2,3, F.W. Wit1,2,4, I.G. Stolte5, M. van der Valk4, S.E. Geerlings4, F. de Wolf6, M. Prins5, P. Reiss1,2,4, on behalf of the AGEhIV Cohort Study Group

1Academic Medical Center (AMC), Global Health, Amsterdam, Netherlands, 2Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, Netherlands, 3Academic Medical Center (AMC), Neurology, Amsterdam, Netherlands, 4Academic Medical Center (AMC), Infectious Diseases, Amsterdam, Netherlands, 5Public Health Service Amsterdam, Infectious Diseases Research, Amsterdam, Netherlands, 6HIV Monitoring Foundation, Amsterdam, Netherlands

Background: HIV-positive patients may be at increased risk of premature onset of age-associated non-communicable comorbidity (AANCC).
Methods: Comprehensive assessment for AANCC in an ongoing prospective cohort study of HIV-1-infected patients ≥45 years from a tertiary care HIV-outpatient clinic, and concurrently recruited HIV-uninfected public sexual health clinic-attendants, comparable regarding age, gender, ethnicity and risk-behavior. Baseline data on AANCC (blood pressure ≥140/90 mmHg, FEV1/FVC< 0.7 and/or self-reported by standardized questionnaire) were analyzed.
Results: Baseline characteristics from the first consecutively enrolled 381 HIV-positive and 349 HIV-negative subjects are listed in the tables.

 HIV neg (n=349)HIV pos (n=381)p-value
Age (years)51.7 (47.5-58.1)53.1 (48.5-59.8)0.022
Male gender84.2%90.6%0.010
Smoking (packyears)3.0 (0.0-19.0)7.6 (0.0-30.8)0.011
Current smokers22.6%31.8%0.006
Alcohol abuse7.2%2.9%0.008
XTC abuse9.5%4.2%0.005
* Data presented as median (IQR) or percentage as appropriate
[Demographic and general characteristics.]

 HIV pos (n=381)
Years documented HIV-1 seropositive (years)12.4 (6.8-17.5)
Mean CD4 count in year prior to enrollment (cells/mm3)548 (421-728)
Nadir CD4 count (cells/mm3)330 (230-450)
HIV-RNA<40 copies/mL during year prior to enrollment84.3%
Prior AIDS21.0%
On cART92.4% (67.2% started from naive and 25.2% started ART-experienced)
Years since start of first ART (years)11.4 (5.3-14.9)
* Data presented as median (IQR) or percentage as appropriate
[HIV-related characteristics]

74.5% of HIV-patients and 61.6% of controls self-reported ≥1 AANCC (p< 0.001). The mean number of AANCC was 1.4 and 1.0, respectively (p< 0.001). Individual AANCC are shown in Figure 1.

Prevalence of different AANCC
[Prevalence of different AANCC]

In every age-stratum the mean number of AANCC was higher among HIV-positives. Similar patterns of AANCC burden appeared to occur 5 years earlier among HIV-positive patients than HIV-negative subjects (Figure 2).

Distribution of number of AANCC over agecategories
[Distribution of number of AANCC over agecategories]

By ordinal logistic regression analysis, after adjustment for age, gender and packyears of smoking, longer documented duration of HIV-seropositivity was associated with a significantly higher risk of an increasing number of AANCC (OR 1.17 per 5 years, 95%CI 1.07-1.27, p=0.0003).
Among HIV-positive patients, after adjustment for age, gender and packyears of smoking, duration of ART-use (OR 1.24 per 5 additional years of ART-use, 95%CI 1.06-1.46, p=0.009) and lower nadir CD4 count (OR 1.12 per 100 less cells, 95%CI 0.99-1.28, p=0.074) were each associated with an increased risk of a higher number of AANCC, whereas documented duration of infection was no longer significant.
Conclusions: In HIV-positive persons ≥45 years of age non-communicable comorbidity was more prevalent compared to controls, and the risk of having an increased number of comorbidities was independently associated not only with age and smoking history, but also with duration of ART-use and severity of documented prior immunodeficiency.

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