Long-term evolution of comorbidities and their disease burden in individuals with and without HIV as they age: analysis of the prospective AGEhIV cohort study

Background People with HIV generally have more ageing-associated comorbidities than those without HIV. We aimed to establish whether the difference in comorbidities and their disease burden changes with ageing.Methods In this prospective, longitudinal cohort study, we assessed comorbidities commonly associated with ageing every 2 years in 596 HIV-positive and 550 HIV-negative participants. HIV-positive participants were recruited from the HIV outpatient clinic of the Amsterdam University Medical Centres (Amsterdam, Netherlands). HIV-negative participants were recruited from the sexual health clinic and the Amsterdam Cohort Studies at the Public Health Service of Amsterdam (Amsterdam, Netherlands). Inclusion criteria were participants aged 45 years or older and, for HIV -negative participants, a documented HIV-negative antibody test. The mean number of comorbidities present over time was compared between groups by use of Poisson regression, accounting for dropout and death through joint survival models. Mean disability-adjusted life-years (DALYs) accrued during 2-year intervals were compared between groups by use of an exponential hurdle model.Findings Between Oct 29, 2010, and Oct 9, 2012, participants were enrolled and then prospectively followed up until their last visit before Oct 1, 2018. 1146 participants were followed up for a median 5 center dot 9 years (IQR 5 center dot 7-6 center dot 0), during which 231 participants (20 center dot 2%) dropped out: 145 (24 center dot 3%) of 596 HIV-positive and 86 (15 center dot 6%) of 550 HIV-negative. 38 (3 center dot 3%) of 1146 participants died: 31 (5 center dot 2%) of 596 HIV-positive and seven (1 center dot 3%) of 550 HIV-negative. 24 HIV-positive and two HIV-negative participants died from ageing-associated comorbidities. 15 HIV-positive participants versus one HIV-negative participant died from non-AIDS malignancies. At inclusion, mean number of comorbidities was higher in HIV-positive participants (0 center dot 65) than in HIV-negative participants (0 center dot 32; p<0 center dot 0001). Mean number of comorbidities increased at similar rates over time: rate ratio (RR) per year for HIV-positive participants 1 center dot 04 (95% CI 1 center dot 00-1 center dot 08), RR per year for HIV-negative participants 1 center dot 05 (1 center dot 01-1 center dot 08; pinteraction=0 center dot 78). Number of comorbidities was associated with an increased risk of death (hazard ratio 3 center dot 33 per additional comorbidity, 95% CI 2 center dot 27-4 center dot 88; p<0 center dot 0001). HIV-positive participants had higher increases in mean DALYs than HIV-negative participants (0 center dot 209 per year, 95% CI 0 center dot 162-0 center dot 256 vs 0 center dot 091 per year, 0 center dot 025-0 center dot 157; pinteraction=0 center dot 0045). This difference was reduced when deaths were excluded in establishing DALYs (0 center dot 127, 0 center dot 083-0 center dot 171 vs 0 center dot 066, 0 center dot 005-0 center dot 127; pinteraction=0 center dot 11).Interpretation The larger comorbidity prevalence in HIV-positive participants aged 50-55 years on effective antiretroviral treatment than in HIV-negative participants increased similarly as participants aged and was associated with an increased risk of death, particularly of non-AIDS malignancies. Our findings reinforce the need for strategies to optimise and intervention.Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved.