Abstract
BackgroundThe objective of the study was to describe the evolution of chronic non-AIDS related diseases and their risk factors, in patients living with HIV (PLHIV) in the French ANRS CO3 Aquitaine prospective cohort, observed both in 2004 and in 2014 in order to improve long-term healthcare management.MethodsThe ANRS CO3 Aquitaine cohort prospectively collects epidemiological, clinical, biological and therapeutic data on PLHIV in the French Aquitaine region. Two cross sectional analyses were performed in 2004 and 2014, to investigate the patient characteristics, HIV RNA, CD4 counts and prevalence of some common comorbidities and treatment.Results2138 PLHIV (71% male, median age 52.2 years in 2014) were identified for inclusion in the study, including participants who were registered in the cohort with at least one hospital visit recorded in both 2004 and 2014. Significant increases in the prevalence of diagnosed chronic kidney disease (CKD), bone fractures, cardiovascular events (CVE), hypertension, diabetes and dyslipidaemia, as well as an increase in treatment or prevention for these conditions (statins, clopidogrel, aspirin) were observed. It was also reflected in the increase in the proportion of patients in the “high” or “very high” risk groups of the disease risk scores for CKD, CVE and bone fracture score.ConclusionsBetween 2004 and 2014, the aging PLHIV population identified in the French ANRS CO3 Aquitaine prospective cohort experienced an overall higher prevalence of non-HIV related comorbidities, including CKD and CVD. Long-term healthcare management and long-term health outcomes could be improved for PLHIV by: careful HIV management according to current recommendations with optimal selection of antiretrovirals, and early management of comorbidities through recommended lifestyle improvements and preventative measures.
Highlights
The objective of the study was to describe the evolution of chronic non-AIDS related diseases and their risk factors, in patients living with Human Immunodeficiency Virus (HIV) (PLHIV) in the French ANRS CO3 Aquitaine prospective cohort, observed both in 2004 and in 2014 in order to improve long-term healthcare management
Life expectancy of people living with HIV (PLHIV) has increased in the last two decades, due to improvements in patient care, including highly effective antiretroviral therapy (ART), HIV RNA suppression and CD4 cell count recovery [1, 2]
In Switzerland, differences in mortality were associated with educational attainment; life expectancy for patients living with HIV (PLHIV), 20 years or older, was 52.7 years for those with only compulsory education (16 years-old), compared to 60.0 years for those with higher education
Summary
The objective of the study was to describe the evolution of chronic non-AIDS related diseases and their risk factors, in patients living with HIV (PLHIV) in the French ANRS CO3 Aquitaine prospective cohort, observed both in 2004 and in 2014 in order to improve long-term healthcare management. Some analyses have shown that life expectancy in PLHIV remains lower compared to the general population. These differences, while they are more pronounced in lower income countries, are present across diverse settings (low and high income) ranging from 60% of HIV-negative life expectancy in Rwanda, to 90% in Canada [3]. Many factors have been associated with mortality, and observed decreases in life-expectancy, among PLHIV. In Switzerland, differences in mortality were associated with educational attainment; life expectancy for PLHIV, 20 years or older, was 52.7 years (95% CI 46.4–60.1) for those with only compulsory education (16 years-old), compared to 60.0 years (95% CI 53.4–67.8) for those with higher education. Male gender, smoking, injection drug use, and low CD4 cell counts at enrolment were independently associated with mortality in PLHIV [4]
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