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NCD Complications in HIV Patients

NCD Complications in HIV Patients. Esteban Martinez Hospital Clínic University of Barcelona Barcelona SPAIN esteban@fundsoriano.es. 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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  1. NCD Complicationsin HIV Patients Esteban Martinez Hospital Clínic University of Barcelona Barcelona SPAIN esteban@fundsoriano.es www.aids2012.org Washington D.C., USA, 22-27 July 2012

  2. 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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. 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

  8. HIV+ patients have a higher prevalence of low bone mineral density Brown TT & Qaqish RB. AIDS 2006; 20: 2165-2174 www.aids2012.org

  9. 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

  10. 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

  11. Neurocognitive impairment remains highly prevalent despite of cART Pre-cART cART Percent impaired HIV+ Heaton R et al. J Neurovirol 2011; 17: 3-16

  12. 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

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

  14. EACS guidelines http://www.europeanaidsclinicalsociety.org/guidelinespdf/2_Non_Infectious_Co_Morbidities_in_HIV.pdf

  15. http://www.aahivm.org/hivandagingforum www.aids2012.org

  16. Growing interest in learning about pathogenesis and care of comorbidities

  17. MostbasicscreeningtoolsforNCDs are easilyaffordable http://hp2010.nhlbihin.net/atpIII/calculator.asp?usertype=prof

  18. Othersmaybenot so easilyaffordable: DXA neededformeasuring BMD www.aids2012.org Washington D.C., USA, 22-27 July 2012

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

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

  21. 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

  22. 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

  23. 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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