Abstract
In Australia, almost half of HIV-positive people are now aged over 50 and are predominately gay and bisexual men (GBM). Compared to the general HIV-negative population, GBM engage more in behaviours that may increase the risk of age-related comorbidities, including smoking, high alcohol consumption and recreational drug use. The objective of APPLES was to compare comorbidities and risk factors in HIV-positive older GBM with an appropriate control group of HIV-negative GBM. We undertook a prospectively recruited cross-sectional sample of HIV-positive and HIV-negative GBM ≥ 55 years. Detailed data collection included clinic data, a health and lifestyle survey, and blood sample collection. We report key demographic, laboratory markers and self-reported comorbidities by HIV status. For selected comorbidities we also adjust HIV status a priori for age, smoking and body mass index. Over 16 months 228 HIV-positive and 218 HIV-negative men were recruited. Median age was 63 years (IQR: 59–67). Although more HIV-positive men reported having ever smoked, smoking status was not statistically different between HIV positive and HIV negative men (p = 0.081). Greater alcohol use was reported by HIV-negative men (p = 0.002), and recreational drug use reported more often by HIV-positive men (p<0.001). After adjustment, HIV-positive men had significantly increased odds of diabetes (adjusted Odds ratio (aOR): 1.97, p = 0.038), thrombosis (aOR: 3.08, p = 0.007), neuropathy (aOR: 34.6, P<0.001), and non-significantly increased odds for heart-disease (aOR: 1.71, p = 0.077). In conclusion, HIV-positive GBM have significantly increased odds for key self-reported comorbidities. This study underscores the importance of an appropriate HIV-negative control group for more accurate evaluation of the risk and attribution of age-related comorbidities in HIV-positive people.
Highlights
More than 50% of the estimated 25,000 people living with HIV (PLHIV) in Australia are estimated to be over 50 years of age [1]
Most HIV negative men were recruited via general practice (GP) (70%) and sexual health clinics (24%), whilst HIV positive men were largely recruited via GP (48%) or tertiary hospitals (33%)
In this sample of HIV positive and HIV negative gay and bisexual men (GBM) over the age of 55 years, an increased prevalence of several self-reported comorbidities including thrombosis, diabetes, heart disease, neuropathy and bone disease was reported by HIV positive men compared to HIV negative men
Summary
More than 50% of the estimated 25,000 people living with HIV (PLHIV) in Australia are estimated to be over 50 years of age [1]. An increased risk of a number of age-related NCDs in PLHIV compared to HIV negative populations has been reported across several studies internationally. More recent studies suggest an increase in NCDs overall, but with little or no age association [20, 21] Causes of these age-related NDCs are an intricate mix of HIV disease itself, ART, genetic factors, co-infections such as hepatitis C (HCV) and hepatitis B virus (HBV), lifestyle factors including cigarette smoking and alcohol use [22, 23], as well as persistent chronic inflammation/ immune activation despite suppressed HIV replication [16, 24,25,26,27,28]. In this paper we report a cross-sectional comparison of the prevalence of self-reported comorbidities and health and behavioural risk factors
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