Annegret Pelchen-Matthews1, Lene Ryom2, Álvaro H Borges2, Simon Edwards3, Claudine Duvivier4, Christoph Stephan5, Helen Sambatakou6, Katarzyna Maciejewska7, José Joaquín Portu8, Jonathan Weber9, Olaf Degen10, Alexandra Calmy11, Dag Henrik Reikvam12, Djordje Jevtovic13, Lothar Wiese14, Jelena Smidt15, Tomasz Smiatacz16, Gamal Hassoun17, Anastasiia Kuznetsova18, Bonaventura Clotet19, Jens Lundgren2, Amanda Mocroft1. 1. Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK. 2. Centre for Health and Infectious Disease Research, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 3. Mortimer Market Centre, London, UK. 4. AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center, Paris Descartes University, Sorbonne Paris Cité, EA7327, IHU Imagine, Paris, France. 5. Infectious Diseases Unit, Goethe University Hospital, Frankfurt, Germany. 6. Ippokration General Hospital, Athens, Greece. 7. Medical University, Szczecin, Poland. 8. Hospital Universitario de Alava, Vitoria-Gasteiz, Spain. 9. St. Mary's Hospital, London, UK. 10. University Clinic Hamburg Eppendorf, Hamburg, Germany. 11. Hopital Cantonal Universitaire Geneve, Geneva, Switzerland. 12. Oslo University Hospital, Ullevaal, Norway. 13. Belgrade University School of Medicine, Infectious & Tropical Diseases Hospital, Belgrade, Serbia. 14. Sjællands Universitetshospital, Roskilde, Denmark. 15. Nakkusosakond Siseklinik, Kohtla-Järve, Estonia. 16. Medical University Gdansk, Poland. 17. Rambam Medical Center, Haifa, Israel. 18. Kharkov State Medical University, Kharkov, Ukraine. 19. Hospital Germans Trias i Pujol, Badalona, Spain.
Abstract
OBJECTIVES: To describe changes in the prevalence of comorbidities and risk factors among HIV-positive individuals in the EuroSIDA study. DESIGN: Comparison of two cross-sectional cohorts of HIV-positive adults under active follow-up in 2006 and 2014. METHODS: Baseline demographics and prevalence of comorbidities were described. Factors associated with the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD) were assessed by logistic regression modelling using generalized estimating equations. RESULTS: Nine thousand, seven hundred and ninety-eight individuals were under active follow-up in EuroSIDA during 2006 and 12 882 during 2014. Compared with study participants in 2006, those in 2014 were older [median age 48.6 years (IQR 40.3-55.1) vs. 43.1 years (37.2-50.0) in 2006] and had higher prevalence of hypertension (59.6 vs. 47% in 2006), diabetes (6.3 vs. 5.4%), CKD (6.9 vs. 4.1%) and CVD (5.0 vs. 3.7%). Individuals in the 2014 cohort had higher odds for CKD (unadjusted OR 2.62, 95% CI 2.30-2.99, P < 0.0001) and CVD (OR 1.88, CI 1.68-2.10, P < 0.0001), but after multivariable adjustment for age group, comorbidities and other factors, year of cohort was no longer significantly associated with the odds of CKD [adjusted OR (aOR) 0.97, CI 0.52-1.82, P = 0.92) or of CVD (aOR 0.94, CI 0.54-1.63, P = 0.82). CONCLUSION: Between 2006 and 2014, the population aged and experienced an overall higher prevalence of non-AIDS comorbidities, including CKD and CVD. The increase in CVD could be explained by the aging population, and the increase in CKD by aging and changes in other factors. Treatment strategies balancing HIV outcomes with long-term management of comorbidities remain a priority.
OBJECTIVES: To describe changes in the prevalence of comorbidities and risk factors among HIV-positive individuals in the EuroSIDA study. DESIGN: Comparison of two cross-sectional cohorts of HIV-positive adults under active follow-up in 2006 and 2014. METHODS: Baseline demographics and prevalence of comorbidities were described. Factors associated with the prevalence of chronic kidney disease (CKD) and cardiovascular disease (CVD) were assessed by logistic regression modelling using generalized estimating equations. RESULTS: Nine thousand, seven hundred and ninety-eight individuals were under active follow-up in EuroSIDA during 2006 and 12 882 during 2014. Compared with study participants in 2006, those in 2014 were older [median age 48.6 years (IQR 40.3-55.1) vs. 43.1 years (37.2-50.0) in 2006] and had higher prevalence of hypertension (59.6 vs. 47% in 2006), diabetes (6.3 vs. 5.4%), CKD (6.9 vs. 4.1%) and CVD (5.0 vs. 3.7%). Individuals in the 2014 cohort had higher odds for CKD (unadjusted OR 2.62, 95% CI 2.30-2.99, P < 0.0001) and CVD (OR 1.88, CI 1.68-2.10, P < 0.0001), but after multivariable adjustment for age group, comorbidities and other factors, year of cohort was no longer significantly associated with the odds of CKD [adjusted OR (aOR) 0.97, CI 0.52-1.82, P = 0.92) or of CVD (aOR 0.94, CI 0.54-1.63, P = 0.82). CONCLUSION: Between 2006 and 2014, the population aged and experienced an overall higher prevalence of non-AIDS comorbidities, including CKD and CVD. The increase in CVD could be explained by the aging population, and the increase in CKD by aging and changes in other factors. Treatment strategies balancing HIV outcomes with long-term management of comorbidities remain a priority.
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