Abstract
ObjectivesWe investigated whether age modified associations between markers of HIV progression, CD4 T lymphocyte count and HIV RNA viral load (VL), and the following markers of metabolic function: albumin, haemoglobin, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC).MethodsA retrospective analysis of data from the United Kingdom Collaborative HIV Cohort was carried out. Analyses were limited to antiretroviral-naïve subjects to focus on the impact of HIV disease itself. A total of 16670 subjects were included in the analysis. Multilevel linear regression models assessed associations between CD4 count/VL and each of the outcomes. Statistical tests for interactions assessed whether associations differed among age groups.ResultsAfter adjustment for gender and ethnicity, there was evidence that lower CD4 count and higher VL were associated with lower TC, LDL-C, haemoglobin and albumin concentrations but higher triglyceride concentrations. Age modified associations between CD4 count and albumin (P < 0.001) and haemoglobin (P = 0.001), but not between CD4 count and HDL-C, LDL-C and TC, or VL and any outcome. Among participants aged < 30, 30–50 and > 50 years, a 50 cells/μL lower CD4 count correlated with a 2.4 [95% confidence interval (CI) 1.7–3.0], 3.6 (95% CI 3.2–4.0) and 5.1 (95% CI 4.0–6.1) g/L lower haemoglobin concentration and a 0.09 (95% CI 0.07–0.11), 0.12 (95% CI 0.11–0.13) and 0.16 (95% CI 0.13–0.19) g/L lower albumin concentration, respectively.ConclusionsWe present evidence that age modifies associations between CD4 count and plasma albumin and haemoglobin levels. A given reduction in CD4 count was associated with a greater reduction in haemoglobin and albumin concentrations among older people living with HIV. These findings increase our understanding of how the metabolic impact of HIV is influenced by age.
Highlights
The number and proportion of older people living with HIV infection are increasing
While older age is associated with an increased risk of many non-AIDS-related causes of morbidity and mortality, independently of HIV infection, there are no data describing whether the impact of HIV disease progression on markers of metabolic function is greater among older people living with HIV compared with their younger peers
CD4 cell count declines are more rapid following HIV infection among older people living with HIV disease [7] and older age is associated with an increased risk of AIDSrelated morbidity after adjusting for the CD4 count [8]
Summary
The number and proportion of older people living with HIV infection are increasing. It is predicted that by 2015 half of the people living with HIV in the USA will be aged 50 years or above [1]. In the UK, the proportion of people living with HIV who are aged > 50 years increased from 12% in 2002 to 22% in 2011, a phenomenon that is thought to be associated with both increased survival and increasing incidence of new infections among older individuals [2]. In the setting of effective antiretroviral therapy (ART), non-AIDS-related disease has become the predominant cause of mortality among people living with HIV [3]. While older age is associated with an increased risk of many non-AIDS-related causes of morbidity and mortality, independently of HIV infection, there are no data describing whether the impact of HIV disease progression on markers of metabolic function is greater among older people living with HIV compared with their younger peers
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