The burden of aging-related comorbidities was higher across every age category in women compared to men, and increased with age.
The overall burden of non-AIDS aging-related comorbidities (NACM) is higher in women versus men, particularly among persons with HIV (PWH), according to the results of a study published in the Journal of the American Medical Association.
Although antiretroviral therapy (ART) has dramatically improved the lifespan of PWH, a gap in comorbidity-free survival exists; between 2014 and 2016, PWH lived 16.3 fewer healthy years than peers without HIV. A factor contributing to this is NACM, which affects PWH earlier and has higher comorbidity rates compared to the general population.
Previous observations indicated that women with HIV had a significantly higher prevalence and incidence burden of aging-related comorbidities than women without HIV. The study researchers sought to assess the association between HIV and comorbidity burden by sex.
The cross-sectional analysis included data from US multisite observational cohort studies of women and men with HIV and socio-demographically comparable HIV-seronegative individuals. Participants in the study were followed from 2008 until the last observation point in 2019.
The main outcome of the study was comorbidity burden, which is the number of total comorbidities out of 10 assessed, per participant. Secondary outcomes included individual comorbidity prevalence, and linear regression examined the association of HIV status, sex, and age with comorbidity burden.
A total of 5929 participants were included in the study, which was comprised of 3238 women (55%) (2316 PWH, 922 HIV-seronegative) and 2691 men (45%) (1452 PWH, 1239 HIV-seronegative). Results of the trial showed a trend of increasing age category being associated with progressively higher mean (SD) NACM burden. For those under 40 years of age, the burden was 1.49 (1.32); ages 40 to 49 years, 2.58 (1.72); ages 50 to 59 years, 3.63 (1.80); ages 60 to 69 years, 4.21 (1.81); and ages 70 years or older, 4.41 (1.73).
Notably, PWH had a higher mean (SD) NACM burden overall compared to persons without HIV (3.47 [1.99] versus 3.03 [1.86]), in addition to across every age category. Furthermore, women had a higher mean (SD) NACM burden than men (3.36 [2.08] versus 3.24 [1.79]; P = .02). However, the differences were not statistically significant among PWH (3.51 [2.06] versus 3.40 [1.88]; P = .07) or persons without HIV (2.99 [2.09] versus 3.06 [1.66]; P = .37).
The estimated mean difference in NACM burden was significantly greater for women versus men in every age group among PWH, though the burden differed for women versus men across age categories among persons without HIV. Adjusting for covariates led to slightly weaker findings but still significantly associated NACM burden with sex.
Among PWH specifically, the estimated mean difference in NACM burden was much higher for women compared to men in every age strata, but this interaction was not significant. Univariable and multivariable results showed that individuals aged 70 years or older versus younger than 40 years of age had an estimated mean (SE) 2.95 (0.18) more comorbidities. Additionally, women with HIV had a 0.31 (0.09) higher comorbidity count versus men with HIV.
The study authors found that the most prevalent NACM were hypertension, psychiatric illness, dyslipidemia, liver disease, and bone disease, and that the distribution of prevalent NACM differed by sex.
Tools that exist to assess comorbidity risk in the general population focus on individual conditions, such as cardiovascular disease and fractures, and underestimate risk in PWH, the researchers wrote. Innovative, holistic approaches to promote healthy aging in HIV that prioritizes screening and prevention of multimorbidity should be supported, especially in consideration of the sociobiologic influences of sex and gender.
“Our findings underscore the need to accurately identify PWH at risk of multimorbidity to offer timely and tailored risk-modification interventions, with consideration given to sex and gender, so that outcomes can be optimized in this population,” the study investigators concluded.
Collins LF, Palella FJ, Mehta CC, et al. Aging-related comorbidity burden among women and men with or at-risk for HIV in the US, 2008-2019. JAMA Netw Open. 2023;6(8):e2327584. doi:10.1001/jamanetworkopen.2023.27584