(O3) The burden of comorbidities in people living with HIV (PLHIV) in Central Denmark Region
Niels A. Jespersen1, Anne G. Ording2, Flemming Axelsen3, Jens Dollerup4, Mette Nørgaard2, Carsten S. Larsen1
1Dept. of Infectious Diseases, Aarhus University Hospital, 2Dept. of Clinical Epidemiology, Aarhus University, 3Gilead Sciences Denmark, 4DMC Medical
Background: HIV infection has become a chronic disease, and PLHIV are now surviving, ageing, and requiring lifelong care and treatment. Across all age groups, PLHIV have an increased risk of chronic complications and comorbidities, such as non-communicable diseases and mental, neurological and substance-use disorders. These conditions may be pre-existing, HIV-associated or due to ageing. The aim of this study was to estimate the prevalence of comorbidities at diagnosis and incidence during follow-up compared to the background population.
Methods: The study population consisted of all PLHIV of the Central Denmark Region during 1985-2017, who were at least 18 years old, and had at least one contact with one of the two HIV-centers in the region. Each HIV patient was matched by age, sex and municipality of residence with ten random comparisons from the background population. Data for both the HIV cohort and the comparison cohort was collected from national Danish registries and managed at Statistics Denmark. Information about Charlson comorbidity index (CCI) were obtained from the Danish National Patient Registry. Using ICD-10 codes we estimated the prevalence and incidence of specific diseases at diagnosis and at 1-, 2-, 5- and 10-years of follow-up. In addition, ATC-codes were used to estimate the treatment with specific medication.
Results: The study included 1.062 PLHIV and 10.620 matched comparisons. Median age was 36.6 years (IQR 29.4-45.4) and 19.7 % were > 50 years old at HIV-diagnosis, with no major changes over time. Of PLHIV, 28 % originated from regions outside Western Europe versus 6 % of the comparisons. The HIV cohort had lower socioeconomic status – shorter education, lower income and higher rate of unemployment. At time of diagnosis 8.7 % of HIV patients had a CCI-score >= 1 (1 = 4.7% and 2 = 4.0 %) versus 5.8 % of comparators (1 = 3.5 % and 2 = 2.3 %). HIV patients had an increased prevalence of chronic conditions at diagnosis, such as ischemic heart disease (2.0 % vs. 1.3 %) including myocardial infarction (MI) (0.8 % vs 0.5 %), COPD (2.2 % vs 1.4 %), mild liver disease (2.4 % vs. 0.4 %), diabetes mellitus (1.4 % vs 1.1 %), moderate to severe renal disease (0.8 % vs 0.3 %), any cancer (2.4 % vs. 1.3 %) including lymphoma (0.8 % vs. 0.1 %), alcoholism-related disorders (4.5 % vs. 2.0 %) and mental disorders (6.5 % vs. 2.9 %). During follow-up there was an increased risk of most chronic diseases including a higher 10-year risk of MI (2.5% versus 1.1%), COPD (5.4% versus 3.0%), dementia (0.6% versus 0.2%) , lymphoma (2.9% versus 0.2%) and moderate to severe renal disease (2,5% versus 0.9%). PLHIV did not have an elevated risk of osteoporosis/fracture, but more were prescribed treatment for osteoporosis. Alcoholism-related and mental disorders continued to be more than 2-fold more prevalent in PLHIV after 10-years of follow-up.
Conclusions: PLHIV have a nearly 50 % higher prevalence of comorbid diseases at diagnosis, indicating that classic risk factors may play a significant role. They continue to have an increased incidence of ischemic heart disease, with a two-fold increased risk of MI, COPD, liver disease, moderate to severe renal disease and lymphoma. Similar, alcoholism-related and mental disorders were more frequent in this group of patients during follow-up. Surprisingly PLHIV had no increased incidence of osteoporosis. PLHIV have an increased burden of non-communicable diseases and HIV-management should include prevention of, screening for and treatment of comorbidities.