Ncd complications in hiv patients
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NCD Complications in HIV Patients. Esteban Martinez Hospital Clínic University of Barcelona Barcelona SPAIN [email protected] www.aids2012.org. Washington D.C., USA, 22-27 July 2012. HIV infection has changed from a fatal disease into a chronic condition.

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NCD Complications in HIV Patients

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Ncd complications in hiv patients

NCD Complicationsin HIV Patients

Esteban Martinez

Hospital Clínic

University of Barcelona

Barcelona

SPAIN

[email protected]

www.aids2012.org

Washington D.C., USA, 22-27 July 2012


Hiv infection has changed from a fatal disease into a chronic condition

HIV infection has changed from a fatal disease into a chronic condition

This means long-term exposure to ART

and higher risk for non-HIV-related conditions

3000

80

ACTIVE PATIENTS

2500

70

60

2000

50

Deaths

Number of patients

1500

Mortality per 100 patient-years

40

30

1000

20

New patients

500

10

0

0

84

86

88

90

92

94

96

98

00

02

Data from Hospital Clinic, Barcelona

www.aids2012.org


Ncd complications in hiv patients

Mortality in HIV-infected adults is still higher than that in general population

Annual incidence of mortality in the Hospital Clínic HIV-infected cohort compared with general population aged 16-65 years in Catalonia

HIV-infected cohort

Mortality per 100 person-years

General population

  • Significant reduction in mortality for HIV-infected patients over this period (P<0.001; χ2 test for trend), but not for the general population (P<0.936; χ2 test for trend)

Martinez et al. HIV Medicine 2007; 8: 251-258

www.aids2012.org


Ncd complications in hiv patients

AIDS-related deaths have decreased, but non-AIDS-related ones have increased

Causes of death in participants from the Swiss HIV Cohort Study in 3 different time periods, and in the Swiss Population in 2007

Years of Death of HIV+ Persons Versus Swiss Population

Ruppik M, et al. 18th CROI; Boston, MA; February 27-March 2, 2011. Abst. 789.


Ncd complications in hiv patients

Non-AIDS-related NCDs in HIV+patients are higher with older age

Swiss HIV Cohort Study

www.aids2012.org

Hasse B et al. Clin Infect Dis 2011; 53: 1130-1139


Ncd complications in hiv patients

Comorbidities not only more common with increasing age but also occur earlier in HIV

Co-mobidities prevalence in cases and controls, stratified by age categories.

The following co-morbidities were analysed: Hypertension, Type 2 Diabetes, Cardiovascular Disease and Osteoporosis.

Co-morbidities prevalence was higher in cases than controls in all age strata (all p-values <0.001).

Guaraldi G et al. Clin Infect Dis 2011; 53: 1120-1126

www.aids2012.org


Ncd complications in hiv patients

HIV-infected patients have a higher incidence of myocardial infarction

A

B

RR 1.75

n = 3,851

12

p <0.0001*

100

10

80

n = 1,044,589

8

60

Events Per 1000 PYs

Events Per 1000 PYs

6

40

4

20

2

0

18-34

35-44

45-54

55-64

65-74

0

HIV+

HIV-

Age Group (Years)

# of MI 189 26,142

* Adjusted for age, gender, race, hypertension, diabetes and dyslipidaemia. Proportion of patients with hypertension, diabetes and dyslipidaemia significantly higher in HIV-positive vs HIV-negative cohort

Triant V et al. J Clin Endocrinol Metab 2007; 92: 2506-2512


Ncd complications in hiv patients

HIV+ patients have a higher prevalence of low bone mineral density

Brown TT & Qaqish RB. AIDS 2006; 20: 2165-2174

www.aids2012.org


Ncd complications in hiv patients

Greater rate of fractures in HIV- infected patients vs un infected individuals

Population-based study

8,525 HIV-infected patients

2,208,792 non HIV-infected patients

3.5

p<0.0001

HIV+

3

HIV-

2.5

2

Fracture prevalence/100 persons

p<0.0001

P<0.0001

1.5

p=0.001

1

0.5

0

All

Vertebral

Hip

Wrist

Triant VA et al. J Clin Endocrinol Metab 2008; 93: 3499–3504


Ncd complications in hiv patients

Liver and kidney comorbidities more common in HIV+ patients

Liver Disease

Renal Disease

Goulet J. Clin Infect Dis 2007; 45: 1593-1601

www.aids2012.org


Ncd complications in hiv patients

Neurocognitive impairment remains highly prevalent despite of cART

Pre-cART

cART

Percent impaired

HIV+

Heaton R et al. J Neurovirol 2011; 17: 3-16


Ncd complications in hiv patients

Non-AIDS–defining cancer rates higher in HIV+ patients vs general population

ASD, Adult and Adolescent Spectrum of Disease Project; HOPS, HIV Outpatient Study; SEER, Surveillance, Epidemiology, and End Results, 1992–2003;

*SRR, standardized rate ratio calculated as ASD/HOPS to SEER populations.

Patel P et al. Ann Intern Med 2008; 148: 728-736

www.aids2012.org


Ncd complications in hiv patients

http://www.europeanaidsclinicalsociety.org/guidelinespdf/2_Non_Infectious_Co_Morbidities_in_HIV.pdf


Eacs guidelines

EACS guidelines

http://www.europeanaidsclinicalsociety.org/guidelinespdf/2_Non_Infectious_Co_Morbidities_in_HIV.pdf


Ncd complications in hiv patients

http://www.aahivm.org/hivandagingforum

www.aids2012.org


Ncd complications in hiv patients

Growing interest in learning about pathogenesis and care of comorbidities


Ncd complications in hiv patients

MostbasicscreeningtoolsforNCDs are easilyaffordable

http://hp2010.nhlbihin.net/atpIII/calculator.asp?usertype=prof


Ncd complications in hiv patients

Othersmaybenot so easilyaffordable:

DXA neededformeasuring BMD

www.aids2012.org

Washington D.C., USA, 22-27 July 2012


Ncd complications in hiv patients

http://www.europeanaidsclinicalsociety.org/guidelinespdf/2_Non_Infectious_Co_Morbidities_in_HIV.pdf


Ncd complications in hiv patients

http://www.europeanaidsclinicalsociety.org/guidelinespdf/2_Non_Infectious_Co_Morbidities_in_HIV.pdf


Ncd complications in hiv patients

The need of polypharmacy means higher risk for interactions and toxicities

Swiss HIV Cohort Study

Comedications

Comorbidities

% participants

N= 5761 2233 450 5761 2233 450

www.aids2012.org

Hasse B et al. Clin Infect Dis 2011; 53: 1130-1139


Summary

Summary

  • The HIV infected population is ageing and NCDs are becoming more prevalent as a cause of morbidity and mortality

  • There is an increasing awareness for screening and management of NCDs in HIV+ patients and specific cost-effective guidelines have been issued

  • Prevention and management for NCDs should be routinely included into the clinical care of HIV+ patients

  • Issues of NCDs screening and management cost, overlapping toxicity of antiretrovirals, and risk of drug interactions will need to be continuously addressed

www.aids2012.org

Washington D.C., USA, 22-27 July 2012


Special thanks

Special thanks:

  • To my colleagues from the HIV Unit at Hospital Clínic, Barcelona, and particularly to Jose Gatell

  • Also to Pere Domingo, Omar Sued, Giovanni Guaraldi, and Julian Falutz for their valuable input

  • To Jordi Blanch, co-organiser of the annual HIV & Neuropsychiatry Symposium in Barcelona

  • and to all the contributors to the recent 2011 version of European AIDS Clinical Society (EACS) guidelines

www.aids2012.org

Washington D.C., USA, 22-27 July 2012


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