Comorbidities in an Aging HIV Positive Population. Brian Risley, MFA 2010 HIV Research Catalyst Forum April 21, 2010. Comorbidities Associated With an Aging HIV Positive Population. I. Comorbidities Renal Lipodystrophy Insulin Resistance / Diabetes Cancer Incidence Bone Density
Brian Risley, MFA
2010 HIV Research Catalyst Forum
April 21, 2010
II. Q & A
Eight year cross-sectional Norwegian survey subjects ≥20 yrs of age
GFR (mL/min/1.73 m2):
N = 65,605
Adapted from Hallan SI, et al. BMJ. 2006; 333:1047-1050.
1Gupta SK, et al. Clinical Infectious Disease. 2005; 40:1559-1585.2Gupta SK, et al. Clinical Nephrology. 2004.; 61:1-6.
Wyatt, CM. AJM. 2007. 120;488-49.
Gupta SK, et al. Clinical Infectious Disease. 2005; 40:1559-1585.
Duration of treatment
Adapted from Lichtenstein KA. JAIDS. 2005;39:395–400.The Causation of Lipodystrophy Is Multi-Factorial in HIV Positive Patients
Falutz J., Nat Clin Pract Endocrinol Metab. 2007 Sep;3(9):651-61.
1Florescu, D. Antiretroviral Therapy. 2007. 12:149-162.2Brown, TT. Arch Intern Med. 2005. 165:1179-1184.3DeWit, D. Diabetes Care. 2008. 31(6):1224-1229.
• Diabetic education
• Self-monitoring of blood glucose
• Aerobic and resistance training
Florescu, D. Antiretroviral Therapy. 2007. 12:149-162.
U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2004 Incidence and Mortality Web-based Report. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute; 2007. Available at: www.cdc.gov/uscs.
(e.g. hyperthyroidism, hyperparathyroidism, liver disease, rheumatological conditions, eating disorders, etc.)
Decreased physical activity
Decreased bone acquisition
Amenorrhoea /premature menopause
(e.g. corticosteroids, anticonvulsants, anticoagulants)
Bone Mineral Density
Diagram adapted from Glesby MJ. Clin Infect Dis 2003; 37:S91–50
Comparison of HOPS cohort (n=8,456) vs National Hospital Discharge Survey and National Hospital Ambulatory Medical Care Survey (NHAMCS)
Adjusted for age and gender
HOPS: 276 fx during median 4.8 yrs follow-up; more likely if:
Nadir CD4+ count <200
Conclusion: Fracture rates are higher in HIV+s and rate is increasing with age
Gender-adjusted rates of fracture among adults aged 25-54 years
P value for trend = 0.01
P value for trend = 0.32
Dao C, et al. 17th CROI; San Francisco, CA; February 16-19, 2010. Abst. 128.
D:A:D Study Group. The Lancet. 2008. 371(9622):1417-26.
Events per 1000 Person-Years
Age Group (Years)MI Rates in HIV Positive and HIV Negative Patients
AMI rate by age group
Cohorts (HIV+ =3851, HIV- =1,044,589) were identified in the Research Patient Data Registry.
The primary outcome was AMI.
Triant VA,et al. J Clin Endocrinol Metab. 2007;92:2506-2512.
= HIV Infection
= HIV Infection & ARTHIV Related Factors that May Contribute to Cardiovascular Disease
Vascular Disease in HIV Positive Patients
Adapted from Dube M, et al. Circulation. 2008;118:e36-e40.
male or female
Systolic Blood Pressure
Treatment for Hypertension (Only if SBP >120)
yes or no
yes or no
Time Frame for Risk Estimate