HIV+ Adults Are at Greater Risk for Myocardial Infarction, Non-AIDS Cancer, and End-stage Renal Disease, but Events Occur at Similar Ages Compared to HIV– Adults
Keri Althoff*1, C Wyatt2, C Gibert1, KA Oursler3, D Rimland4, M Rodriguez-Barradas5, K McGinnis6, M Skanderson6, K Gebo7, A Justice6, for Veterans Aging Cohort Study
1VAMC and George Washington Univ Med Ctr, Washington, DC, US; 2Mt Sinai Sch of Med, New York, NY, US; 3Univ of Maryland and VA Maryland Hlth Care System, Baltimore, US; 4Atlanta VAMC and Emory Univ Sch of Med, GA, US; 5Baylor Coll of Med and the Michael E DeBakey VAMC, Houston, TX, US; 6Yale Univ and the VA Connecticut Hlthcare System, New Haven, US; and 7Johns Hopkins Univ, Baltimore, MD, US
Background: Premature aging in HIV+ adults is not the same as being at increased risk for disease. One may be at greater risk of disease yet may experience events at similar or dissimilar ages. The objective of this study was to examine differences in the mean age at diagnosis for, and the risk of, the following age-related comorbidities in HIV+ and HIV– adults: myocardial infarction (MI), non-AIDS-defining cancers (cancer), and end-stage renal disease (ESRD).
Methods: Incident clinically-validated MI, registry-matched cancers, and Medicare-confirmed ESRD events in participants from the Veterans Aging Cohort Study Virtual Cohort occurring October 2003-September 2008 were included; prevalent cases were excluded. Participants were matched (1 HIV+ to 2 HIV– veterans) by age, gender, race/ethnicity, and clinical site. Differences in the mean age at comorbidity diagnosis and 95% confidence intervals (CI) were estimated using linear regression models. Incidence rates (IR) and adjusted incidence rate ratios (aIRR) were estimated using Poisson regression models.
Results: MI: Of the 84,444 veterans without a history of coronary heart disease, mean age at MI was 55.3 years in both HIV+ and HIV– veterans (standard deviation (SD): HIV– = 8.0, HIV+ = 8.5; p = 0.99; Table 1). Adjusted mean age at MI was not statistically significantly different in HIV+ compared with HIV– veterans. There was an 81% increase in the risk of MI by HIV status after adjustment. Cancer: Mean age at cancer diagnosis was 55.7 (SD = 9.7) and 58.5 (SD = 8.0) years among HIV+ and HIV–veterans, respectively (N = 97,134; p <0.001). Adjusted mean age at cancer diagnosis was slightly younger in HIV+ compared with HIV– veterans. There was a 37% increase in the risk of cancer by HIV status after adjustment. ESRD: Mean age at diagnosis was 55.0 (SD = 10.1) years in HIV+ and 58.3 (SD = 10.3) years in HIV– (N = 99,433; p <0.001), respectively. Adjusted mean age at ESRD was not statistically significantly different in HIV+ compared with HIV– veterans. There was 55% increase in the risk of ESRD by HIV status after adjustment. Traditional risk factors were statistically significantly associated with incident events for these age-related comorbidities.
Conclusions: Although HIV+ adults are at a substantially greater risk of MI, cancer, and ESRD than HIV– adults in care, these age-related co-morbidities occur at similar ages after accounting for traditional risk factors.