Women on ART with high HIV viral load at increased risk of non-AIDS comorbidities
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Women with HIV who had greater cumulative viremia had an increased risk of multimorbidity and developing five vascular-related non-AIDS comorbidities, according to a recent study.
“In prior analyses evaluating the burden of non-AIDS comorbidities in women with and without HIV, we found that the overall burden of 10 comorbidities assessed was higher in women with vs. without HIV, and that comorbidity burden in women with HIV was primarily associated with traditional as opposed to HIV-related risk factors,” Lauren F. Collins, MD, MSc, assistant professor of medicine in the division of infectious diseases at Emory University, told Healio.
“This prompted us to evaluate the contribution of HIV-related factors longitudinally, as opposed to single time point measures, as we hypothesized that their impact on the development of non-AIDS comorbidities likely accumulates and compounds over time,” Collins said.
According to Collins, it is well established that inflammation related to chronic HIV contributes to risk of aging-related non-AIDS comorbidities.
She said that there is emerging literature establishing the link between ongoing HIV-1 replication being a stimulus for HIV-associated inflammation and immune activation, even despite HIV treatment with antiretrovirals.
“This prompted us to evaluate whether cumulative HIV-1 viremia affected incident multimorbidity in women with HIV after initiation of antiretroviral therapy,” Collins said. “We focused on women given the higher risk of aging-related comorbidities in this population.”
For the study, the researchers assessed women with HIV with 2 or more plasma HIV-1 viral loads (VL) less than 200 copies/mL within a 2-year period following self-reported ART use. According to the study, the primary outcome was multimorbidity, defined as two or more non-AIDS comorbidities of five assessed in the study.
In total, 806 women with HIV contributed 6,368 women-years, with median 12 VL per woman.
Of the 211 (26%) women who developed multimorbidity during the study, 162 (77%) had incident hypertension, 133 (63%) dyslipidemia, 60 (28%) diabetes, 52 (25%) cardiovascular and 32 (15%) kidney disease.
The researchers found that, compared with women with HIV who had time-updated cumulative viremia copy years (VCY) less than 5 log10, the adjusted HR of multimorbidity was 1.99 (95% CI, 1.29-3.08) and 3.78 (95%CI 2.17-6.58) for those with VCY of 5 to 6.9 and 7 or more log10 copy-years/mL, respectively (P < .0001).
“Among women with HIV treated with antiretrovirals, greater cumulative viremia increased the risk of multimorbidity and of developing each of five specific non-AIDS comorbidities,” Collins said. “In the modern HIV treatment era, cumulative HIV-1 viremia may be a prognostically useful biomarker for non-AIDS comorbidity risk assessment in this population.”
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