by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

October 1, 2019

Featured Literature:
Palella, FJ et al. for the HIV Outpatient Study (HOPS). Non-AIDS comorbidity burden differs by sex, race, and insurance type in aging adults in HIV care. 
AIDS: August 22, 2019 – Epub ahead of print doi: 10.1097/QAD.0000000000002349            

As the population of persons living with HIV (PLWH) continues to age, diagnosing, monitoring, and treating non-AIDS-related comorbidities (NACMs) has become increasingly important for providers. This prospective study from the HIV Outpatient Study (HOPS) cohort in the United States looked at patients in care from 1997 through June 2015 and who were followed for greater than five years. All were receiving antiretroviral therapy and had undetectable viral loads (< 200 copies/mL) at least 75% of the time while in care. For this study, NACMs included anemia, arthritis, cancer, CVD, diabetes, hyperlipidemia, hypertension, viral hepatitis, and psychiatric conditions. Of 1,540 patients, 81% were male and 61% were MSM. Age strata included 18-40 years, 41-50 years, 51-60 years, and > 61 years of age. The median time of observation was approximately 11 years with a range of 5 to 18 years. The mean number of NACMs increased significantly with each advancing age category – ranging from 1.4 in the youngest group to 3.9 in the > 61 age group. The prevalence of most NACMs also increased with age. Age-related differences in the number of conditions were primarily due to anemia, diabetes and HCV infection. Of note, women had more NACMs than men at 4 compared to 3.4. Non-Hispanic blacks had a mean of 3.8 NACMs compared to other races. Those with public versus private insurance also had more comorbidities with 4.3 vs 3.1. The authors believe these data support the need for increasing prevention and screening for NACMs.

Author’s Commentary:

This study adds to what many of us see in clinical practices with our aging HIV patients who need more time, more periodic health screenings, and are also experiencing polypharmacy. I am now seeing many of my long-term patients at three-month intervals or even one-month follow-up visits. For HIV clinicians who also serve as the patient’s PCP, it is very challenging to address all of their medical conditions and needs effectively or appropriately with just two visits per year.

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