As the HIV population ages, a variety of health challenges may arise that typically happen in populations without chronic conditions.
One of the more interesting aspects of HIV care is that people living with HIV (PLWH) on antiretroviral therapies (ART) are living longer and may be susceptible to comorbidities typically associated with healthy, aging populations.
Parastu Kasaie, PhD, assistant scientist, Johns Hopkins Bloomberg School of Public Health led a group of investigators who studied projections of multimorbidities in PLWH who are taking ART. They simulated what types of health issues this patient population might be dealing with by the year 2030. Their modeling study, titled ProjEcting Age, MultimoRbidity, and PoLypharmacy (PEARL) looked at 9 mental and physical comorbidities: depression and anxiety, treated hypertension, diabetes, hyperlipidemia, chronic kidney disease (CKD), cancer, myocardial infarction (MI), and end-stage liver disease (ESLD). They did modeling projections knowing the presence and/or absence of 3 underlying risk-factors, including smoking, Hepatitis C virus infection, and body mass index change 2-year post-ART.
In terms of the population, they looked at 15 key-groups in the United States that were defined by, "race/ethnicity (White, Black, and Hispanic), sex (male, female), and acquisition risk group (men who have sex with men [MSM], injection drug use [IDU], and heterosexual contact),” the investigators wrote.
“The main purpose of our study was really understanding the changes in the aging phenomenon in this population,” Kasaie stated.
Their findings showed that, “Hispanic heterosexual women experienced the largest multimorbidity burden increase (absolute difference=23.5%), while multimorbidity burden reduced slightly among White and Black heterosexual men (<-2% change)."
The long-term expectations is that many PLWH who continue to take ART will get older and experience age-related comorbidities. This is promising as the modeling shows that while HIV is a chronic condition, people can live with it for years, according to Kasaie.
Racial disparities were one of the bigger findings associated with time. “Accompanying an increase in median age of PWH (50 to 53 years), the projected prevalence of multimorbidity increased from 2020 to 2030 overall (from 30.3% to 34.7%) and among all 15 key-populations,” the investigators reported. “Racial disparities expand over time, with the highest and lowest multimorbidity burden projected among Black injection drug users (IDU) women (74.7%) and Hispanic men who have sex with men (MSM) (20.9%) in 2030.”
“Over the next decade, the most prevalent comorbidities that we are projecting are hypertension, CKD, and hyperlipidemia,” Kasaie said. In addition, mental health issues including anxiety and depression were very high across all key population groups the investigators wrote.
Contagion spoke with Kasaie who provided an overview of the study, aspirations for the study's findings, and the importance of understanding the care needs for the aging PLWH population.