Healthy With HIV, But Facing More Aging Issues

Research presented at the IDWeek 2016 meeting earlier this year showed an increase in the number of HIV-positive people experiencing comorbidities — such as cardiovascular disease, kidney malfunction, and bone loss — as they age. 

Almost one-third of people living with HIV in the U.S. are over 50, according to the Centers for Disease Control and Prevention, and it is estimated in 2017 that the number will increase to nearly half. 

While today's antiretroviral therapies are enabling positive individuals to live longer and healthier lives, HIV-positive people remain at higher risk for developing additional chronic conditions such as heart disease and cancer, reports NAM's AIDSMap. In fact, some of these conditions are linked to specific antiretroviral drugs, like tenofovir (Viread) and abacavir (Ziagen). Many of the adults living with HIV over 50 are long-term survivors, who have increased risks due to the length of time they've been positive and on medications.

In the recent study, researchers used Truven Health MarketScan Databases — which has  data on nearly 230 million patients going back to 1995 — and pulled the medical information for 21,180 HIV-positive people (diagnosed and treated with antiretroviral medications from 2003 to 2013) and 66,027 HIV-negative people; and analyzed their comorbidity rates. HIV-positive people were more likely to have nearly every disease considered versus their HIV-negative counterparts, although the extent of that higher risk varied by condition.

For those who had commercial health insurance, seven percent of HIV-positive people had cardiovascular disease versus 4 percent of HIV-negative people; 9 percent of poz people had kidney disease vs. 3 percent of negative people. For osteoporosis and fractures, it was 8 percent vs. 6; hypertension, 31 vs. 30 percent; hyperlipidaemia, 31 percent vs 30; and endocrine disease, 21 percent vs. 18. Aditionally, HIV-positive people were more likely to have hepatitis C (5 vs. 1 percent).

Researchers then compared people who had Medicaid instead of commercial insurance, and found those with the government assistance had even higher risks. For cardiovascular disease, it was 11 percent for HIV-positive people vs. 8 percent HIV-negative people; kidney disease, 15 percent vs. 6 ; osteoporosis and fractures, 13 vs. 10 percent; hypertension, 37 percent vs. 34; hyperlipidaemia 22 vs. 24 percent; endocrine disease 26 percent vs. 25; and hep C, 23 percent vs. 4 percent.

Clearly this group represents the approximately 25 percent of people with HIV who also have hep C. We do know that hepatitis C impacts African-Americans disproportionately (and those folks also more likely to have Medicaid). Numbers like these have led the government to launch a new initiative aimed specifically at people of color living with both HIV and hep C.

The researchers also showed that rates of cardiovascular disease, kidney impairment, and fractures have risen significantly in both HIV-positive and HIV-negative people between 2003 and 2013. 

"HIV patients have multiple non-AIDS-related comorbidities, including risk factors for renal impairment, cardiovascular disease, and fracture/osteoporosis," the researchers concluded. "Among treated HIV patients, the prevalence of comorbidities is increasing over time, especially renal, bone, and cardiovascular comorbidities."