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HIV Glasgow: French Study Reveals Growing Complexity of Medical Needs as People with HIV Age


The complexity of the needs of people living with HIV will continue to increase as the population ages, and clinicians need to go beyond thinking about co-morbidities to consider multi-morbidities -- clusters of medical conditions that complicate one another -- when caring for these people, Edouard Battegay from the University Hospital Zurich told attendees at the International Congress on Drug Therapy in HIV Infection (HIV Glasgow) this week.

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Following analysis of multi-morbidity in the general population, researchers found that medical conditions tended to cluster into 8 groups, and that individuals tended to fall into one of these clusters. For example, they found a strong relationship between dementia, depression, and hip fracture, but much less frequent overlap between coronary heart disease and hip fracture and depression. Instead, people experiencing cardiovascular problems tended also to frequently have thyroid dysfunction and chronic obstructive pulmonary disease.

These patterns of clustering indicate which groups of specialists might need to work together more frequently, and who needs to be involved in the care of people living with HIV.

Battegay suggested that among people with HIV, a number of clusters of multi-morbidity present with greater frequency, such as HIV infection, depression, and pain, or HIV, depression, and non-adherence. HIV and hypertension overlap with cardiovascular disease, and may also overlap with pain. Further research is needed to examine these clusters so as to assist in the development of algorithms for the management of multiple morbidities, such as those recently issued by the European AIDS Clinical Society.

Research from France also presented at the conference showed that by the time people with HIV reach middle age, a high proportion already have complex medical problems requiring multidisciplinary management. The study found that just over half were at high risk for serious kidney disease, 46% were at high or very high risk of a cardiovascular event in the next 5 years, and 56% had hypertension.

Investigators from the Aquitaine regional cohort wanted to establish a clear understanding of the evolving medical needs of HIV-positive patients in the modern antiretroviral therapy era. They therefore analyzed cross-sectional data gathered from patients enrolled in the prospective ANRS CO3 Aquitaine cohort to see how the spectrum of health problems observed in HIV-positive patients changed between 2004 and 2014.

A total of 2138 patients had study visits in both 2004 and 2014. Most (71%) were male, 40% were men who have sex with men, and the median age in 2014 was 52 years. 62% of the cohort was over 50 years of age in 2014.

HIV markers improved over the 10 years of the study. The proportion of patients with an undetectable viral load increased significantly, from 51% in 2004 to 91% in 2014. This was accompanied by a significant increase in the proportion of people with a CD4 cell count above 500 cells/mm3, from 44% in 2004 to 72% in 2014.

However, there was also a significant increase in the proportion of patients diagnosed with age-related comorbidities and taking therapy for these ailments.

Prevalence of chronic kidney disease increased from 4% to 18%, fractures from 1% to 7%, cardiovascular disease events from 4% to 14%, use of blood thinning agents from 1% to 8%, therapy with aspirin from 1% to 8%, hypertension from 19% to 56%, diabetes from 8% to 19%, use of anti-diabetic therapy from 2% to 6%, prevalence of elevated lipids from 14% to 54%, and use of statins from 9% to 24%.

Of particular concern, the proportion of people with a Framingham high risk score (5%-10%) for cardiovascular disease increased from 13% to 27%, while the proportion with a Framingham score above 10% -- indicating a risk of 1 in 10 or more of having a cardiovascular event (either stroke or heart attack) in the next 5 years -- had jumped from 5% to 20%. In other words, 1 in 5 people in the cohort are now at very high risk of a cardiovascular event, compared to 1 in 20 a decade ago.

Similarly, the proportion of patients with the highest risk of kidney disease, as measured on the D:A:D renal risk score, had risen from 30% in 2004 to 51% in 2014, indicating the importance of selecting antiretroviral regimens that minimize the risk of further loss of kidney function.



F Bonnet, F Le Marec, O Leleux, et al. HIV patients today and 10 years ago: do they have the same needs? Results from cross-sectional analysis of ANRS CO3 Aquitaine cohort. HIV Drug Therapy 2016. Glasgow, October 23-26, 2016. Abstract 0212, 2016.