People with HIV and Uninfected People Diagnosed with Age-related Diseases at Similar Ages

HIV positive people are more likely than HIV negative individuals to have heart attacks and develop end-stage kidney disease and non-AIDS cancers in the era of effective antiretroviral therapy, but they do so at around the same ages, on average, according to study of U.S. veterans published in the October 30 edition of Clinical Infectious Diseases.

Several observation studies have found that people with HIV experience age-related conditions such as cardiovascular disease, liver and kidney disease, and non-AIDS-related malignancies more often than their HIV negative counterparts. However, it remains unclear whether or not these conditions occur earlier, which would suggest that HIV infection promotes accelerated aging.

Keri Althoff from Johns Hopkins Bloomberg School of Public Health and colleagues compared the risk of 3 age-associated conditions -- myocardial infarction (MI), end-stage renal disease, and non-AIDS-defining cancers -- and the ages at which they occur in HIV positive and negative adults.

The researchers used data from the Veterans Aging Cohort Study, a prospective study of HIV positive and demographically matched uninfected U.S. veterans, collected from April 2003 through December 2010, after the widespread availability of effective antiretroviral treatment. The analysis included data from 98,687 total mostly male participants, about one-third of whom were living with HIV. During this period, there were 689 MIs, 1135 cases of end-stage kidney disease, and 4179 non-AIDS cancer diagnoses.

HIV positive participants were at greater risk for all 3 outcomes compared to HIV negative adults after adjusting for confounding factors. However, the mean age for having a heart attack or developing non-AIDS cancers did not differ according to HIV status, and HIV positive people diagnosed with end-stage kidney disease were just 5.5 months younger than negative people.

"HIV-infected adults had a higher risk of these age-associated events, but they occurred at similar ages [as] those without HIV," the study authors concluded.

Below is an edited excerpt from a Johns Hopkins press release describing the study and its findings in more detail.

HIV-Infected Adults Diagnosed with Age-Related Diseases at Similar Ages as Uninfected Adults

Successful treatments are helping HIV-infected persons achieve similar longevity as those without HIV

November 11, 2014 -- New research from the Johns Hopkins Bloomberg School of Public Health suggests that HIV-infected adults are at a higher risk for developing heart attacks, kidney failure, and cancer. But, contrary to what many had believed, the researchers say these illnesses are occurring at similar ages as adults who are not infected with HIV.

The findings appeared online last month in the journal Clinical Infectious Diseases.

Researchers say these findings can help reassure HIV-infected patients and their health care providers.

"We did not find conclusive evidence to suggest that screening for these diseases should occur at younger ages in HIV-infected compared with uninfected adults," says Keri N. Althoff, PhD, MPH, an assistant professor in the Department of Epidemiology at the Bloomberg School and lead author of the study.

Using data from 98,687 HIV-infected and uninfected adults in the Veterans Aging Cohort Study from April 1, 2003, to December 31, 2010, the researchers were able to compare the ages at which each group was diagnosed with heart attacks, kidney failure, and cancers unrelated to AIDS. Althoff and her colleagues found that HIV-infected adults were diagnosed with kidney failure, on average, when they were six months younger than the group without HIV. There were no statistically significant age differences at diagnosis between infected and uninfected adults for heart attacks or cancers unrelated to AIDS.

The study also compared the risk of these age-related diseases in HIV-infected and uninfected adults. Similar to previous studies, HIV-infected adults appear to be at an increased risk of these diseases, but the magnitude of the increase in risk was smaller than has been reported in many of the previous studies, likely due to this study’s ability to adjust for factors such as race, gender, obesity, smoking, diabetes, and depression, among others, influencing the risk in both HIV-infected and uninfected adults.

In the early years of the AIDS epidemic, HIV was a death sentence. But in recent years antiretroviral therapy (ART) has been proven highly effective at suppressing HIV viral replication and increasing longevity for people with HIV. A study published in December 2013 in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) shows that the life expectancy among HIV-infected adults is only a few years shy of the U.S. general population.

While HIV-infected people are living longer, there has been a contentious debate in medical circles about whether they are undergoing an accelerated aging process. People living with HIV have demanded a more rigorous study of whether and why this may be happening.

Just because the data show that the onset of these three diseases is similar between those with and without HIV doesn’t mean those with HIV are just as healthy, Althoff cautions.

"Many HIV-infected adults feel older than their age," she says. "Our study looks at three important age-related diseases and we find no meaningful difference in age at diagnosis. But this isn’t the whole story. We need more research to figure out what is going on."

11/19/14

Reference

KN Althoff, KA McGinnis, CM Wyatt, AC Justice, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected vs uninfected adults. Clinical Infectious Diseases. October 30, 2014 (Epub ahead of print).

Other Source

Johns Hopkins Bloomberg School of Public Health. HIV-Infected Adults Diagnosed with Age-Related Diseases at Similar Ages as Uninfected Adults. Press release. November 11, 2014.