Women with HIV face greater age-related comorbidity burden
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Key takeaways:
- The overall burden of ten age-related comorbidities were significantly more common in women vs. men, especially in those with HIV.
- The data could help inform age-related morbidity screenings and interventions in patients with HIV.
The burden of age-related comorbidities was greater in women compared with men, particularly among those with HIV, a recent study in JAMA Network Open found.
“Due to the success of antiretroviral therapy, persons with HIV are living longer and increasingly experience aging-related comorbidities,” Lauren F. Collins, MD, MSc, an assistant professor of medicine in the division of infectious diseases at Emory University, told Healio. “While sex differences in the aging experience have been noted in the general population, potential differences among women vs. men aging with HIV have not been well characterized.”
Data derived from: Collins F, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.27584.
Therefore, the researchers conducted a cross-sectional analysis to examine whether HIV was linked to “aging-related comorbidity burden differentially by sex in the largest and longest observational U.S. aging cohort of persons with and without HIV (the MACS/WIHS Combined Cohort Study),” Collins said. They measured each participant’s non-AIDS comorbidity (NACM) burden, defined as the total number of NACMs out of a possibility of 10.
In the cohorts, men and women were followed from 2008 and 2009, respectively, to 2019. The final analysis included 5,929 participants, 55% of whom were women, who had a mean age of 54 years.
Overall, the unadjusted mean comorbidity burden was higher in women vs. men (3.4 vs. 3.2). Compared with men, women had higher comorbidity prevalence for diabetes (24% vs. 17%), bone disease (42% vs. 19%) and lung disease (38% vs. 10%). However, they had a lower prevalence for several other conditions, including hypertension (75% vs. 68%), psychiatric illness (58% vs. 55%), dyslipidemia (64% vs. 41%) and liver disease (38% vs. 34%).
The researchers reported that the sex disparity was significantly greater in women vs. men among persons with HIV for all age ranges, with an estimated mean difference (MD) of:
- 0.33 (95% CI, 0.03-0.63) for those aged younger than 40 years;
- 0.37 (95% CI, 0.12-0.61) for those aged 40 to 49 years;
- 0.38 (95% CI, 0.2-0.56) for those aged 50 to 59 years;
- 0.66 (95% CI, 0.42-0.9) for those aged 60 to 69 years; and
- 0.62 (95% CI, 0.07-1.17) for those aged 70 years and older.
However, NACM burden for women vs. men varied in different age categories among those without HIV, with an estimated MD of:
- 0.52 (95% CI, 0.13-0.92) for those aged younger than 40 years;
- –0.07 (95% CI, –0.45 to 0.31) for those aged 40 to 49 years;
- 0.88 (95% CI, 0.62-1.14) for those aged 50 to 59 years;
- 1.39 (95% CI, 1.06-1.72) for those aged 60 to 69 years; and
- 0.33 (95% CI, –0.53 to 1.19) for those aged 70 years and older.
Collins said it was not entirely surprising that women had an overall higher comorbidity burden.
“We were intrigued, however, by the distribution of prevalent comorbidities differing by sex and by our data highlighting the important role that social determinants of health likely play in mediating differences in comorbidity prevalence and burden in women vs. men,” she said.
Such data “could pave the way for aging-related multimorbidity screening and prevention tools and strategies to be developed and appropriately tailored, with the goal of mitigating comorbidity effects that may accumulate and compound across the lifespan,” the researchers wrote.
According to Collins, primary care physicians “should remain vigilant about comorbidity screening and prevention in persons with HIV and appreciate differences in risk by sex as well as limitations in currently available comorbidity risk-assessment tools that are usually focused on individual comorbidities (vs. multimorbidity) and that are insensitive among persons with HIV and women in particular.”
Perspective
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The findings revealed that women had a higher incidence of comorbidities than men. The comorbidities seen were diabetes, hypertension, heart disease, bone disease, hyperlipidemia, mental health and substance abuse. Most of the women were of color. The hormonal effects including menopause also led to higher NACM than men. Women tended to be less adherent to appointments and getting lab tests because of underlying mental health and substance abuse, all leading to poorly controlled NACM.
Many times, women tend to have more stigma related to their disease as well as socioeconomic status, which can reduce their access to care. I currently work at a health department in Lansing, Michigan, and because we have many aging women, we have a multispecialist approach to be holistic in their care and promote healthy aging in HIV care. We promote screening for various diseases and integrate their HIV care with traditional care such as substance abuse, mental health, diabetes, heart disease, bone disease and cancer screening.
The article helps to identify the fact that as patients with HIV age, they have many more non-AIDS-related comorbidities to consider, and aging women with HIV have a high risk. That means they should be treated and monitored not only for HIV factors, but to consider sociobiological influences in their care and to do age-related comorbidity risk assessment intervention and prevention for their overall health care.
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