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MI, ESRD occur at similar ages among those with, without HIV
ATLANTA — Common age-related comorbidities — myocardial infarction and end-stage renal disease — appear to occur at similar ages among patients with and without HIV. However, non-AIDS-defining cancers appeared to occur 6 months earlier among those with HIV, Keri Althoff, PhD, MPH, said here at the 2013 Conference on Retroviruses and Opportunistic Infections.
Keri Althoff
“We know people with HIV are living for longer periods of time and now they are living with age-related complications. The question is: Are HIV-infected adults prematurely aging? In a clinical context, premature aging can be defined as a younger age at age-related disease diagnosis in HIV-infected compared to uninfected adults. Previous studies have shown a dramatic decrease in the age at diagnosis among HIV-infected adults, but differences in the age distributions of the HIV-infected and uninfected adults, and the inability to control for many important risk factors were limitations of these studies,” said Althoff, of Johns Hopkins Bloomberg School of Public Health.
Althoff discussed findings from a study that assessed data on patients included in the Veterans Aging Cohort Study (VACS) between October 2003 and September 2008. For every one HIV-infected patient, two HIV-uninfected patients were matched according to sex, age, race and clinical site at entry into the VACS, ensuring a similar age distribution in the HIV-infected and uninfected groups.
Crude mean age at first MI was 55.3 years among those with and without HIV who did not have a prior history of MI (n=84,444). In adjusted analyses, there was no difference in mean age at MI diagnosis. There was an 81% increase in the risk for MI in patients with vs. those without HIV in adjusted analyses.
For end-stage renal disease (ESRD), crude mean age at diagnosis among those with HIV was 55.3 years vs. 58.5 years among those without HIV. However after adjustment for confounders, there was no statistically significant difference in age at ESRD by HIV status (n=99,252). HIV-infected adults had a 43% increase in the rate for ESRD compared with HIV-uninfected adults in the adjusted analysis.
Compared with a mean age of 54.9 years for HIV-associated (anal, liver, lung, oral and non-Hodgkin lymphoma) cancer diagnosis among those with HIV, the mean age for cancer diagnosis among those without HIV was 57.8 years (n= 97,666). In adjusted analyses, mean age at diagnosis was 7 months younger in HIV-infected adults.
HIV-infected adults had an 84% increase in the rate for HIV-associated cancers compared with HIV-uninfected adults in adjusted analyses. For other non-AIDS defining cancers, HIV-infected adults were diagnosed at an mean age that was 5 months younger compared with those without HIV in adjusted analyses, but no difference was observed in the rate for non-AIDS-defining cancers by HIV status.
“We found that for MI and ESRD, these events were occurring at the same age as those without HIV, which does not support the hypothesis of premature aging in a clinical context and in regards to these outcomes,” Althoff said. “For our non-AIDS-defining cancer outcome, we found that our HIV-infected individuals had cancer diagnosis about 6 months younger than HIV uninfected individuals — a very modest difference — but it was statistically significant. The clinical and public health significance of this is undetermined.”
For more information:
Althoff K. #59. Presented at: 2013 Conference on Retroviruses and Opportunistic Infections; March 3-6; Atlanta.
Disclosure: Althoff reports no relevant financial disclosures.
Keri Althoff, PhD, MPH, can be reached at 615 N Wolfe St. Rm E7142, Baltimore, MD 21205; email: kalthoff@jhsph.edu.