Swiss study tracks aging HIV+ patients

New reseach tracks rates of non-HIV related diseases in HIV+ patients as they age Keystone

The treatment and prevention of non-HIV related diseases is becoming more important for sufferers of the immunodeficiency virus as they age, a study has found.

Carried out by the Swiss HIV Cohort, which pools the work of several medical researchers and practitioners involved with HIV from around the country, it examined the incidence of clinical events in nearly 9,000 HIV positive patients from January 2008 to December 2010.

Lead author Barbara Hasse, from the Division of Infectious Diseases and Hospital Epidemiology at Zurich University Hospital, tells swissinfo.ch the study shows that HIV is treatable and sufferers can live a normal life.

But people aged over 65 who were HIV positive ran a greater risk of contracting non-HIV or non-Aids related diseases, regardless of whether they were taking antiretroviral therapy (ART) drugs or not.

The Cohort also documented the evolution of age in HIV+ patients. It found that from 1990 to 2010, the proportion of patients who were aged 50-64 increased from three per cent to 25 per cent, confirming that as antiretroviral treatments have improved people are living longer.

swissinfo.ch: What are the main findings of this study?

Barbara Hasse: The main findings of this study were that co-morbidities [secondary diseases] are an increasing topic in HIV medicine – particularly non-Aids co-morbidities – and that they occur with Aids and despite antiretroviral treatment. So it doesn’t matter if you take ART or not. What is also very important is that there needs to be an increased focus on prevention [of other diseases] in HIV medicine. That is, prevention of cardio vascular disease, lung disease, primary care things which are also important for our HIV patients because they are aging. As they get older they have the opportunity of getting normal aging illnesses.

swissinfo.ch: Did this study tell you anything about the way ART reacts to medications for other diseases?

B.H.: We just looked at the numbers and how many co-medications we had. This was because there was another study which is looking at potential drug interactions between the HIV medications and other co-medications at the same time in the aging population. But this is a huge problem with polypharmacy in people who are getting older.

swissinfo.ch: Why is it difficult to compare how illnesses behave in HIV+ and non-HIV+ patients?

B.H.: The ideal comparative group would be the person with the same smoking behaviour, the same age, as our HIV patient. Ideally it would be a person around 45 years old, who has a modest alcohol consumption, with maybe smoking behaviour, and a small subset of intravenous drug users… tell me where do you find this group? This is really the problem and also with all sorts of disease, there is no population-based system where you systematically look for a cohort.  

What we are trying to do now is ask primary care physicians if they can provide us with data about multi-morbidities [several concurrent diseases] in their subsets of patients, so we can compare those two groups.

swissinfo.ch: Is HIV still the death sentence it once was? This study seems to suggest that people with HIV are dying from non-HIV related illnesses…

B.H.: This study is like the proof that HIV is a treatable, chronic disease. It can’t be healed but it can be treated or controlled, so that patients can lead a good life. Over 90 per cent of our people are working and living a normal life except that they are HIV+, so it’s a very positive sign.

But on the inverse you have a disease more when you are getting older, for example perhaps you are developing cardio vascular disease. Our subset of patients has more alcohol and nicotine involved so it’s really even more important to focus on [disease] prevention.

swissinfo.ch: If HIV can now be controlled, should we be looking at combining HIV and primary care treatment under one generalist doctor?

B.H.: I think there must be an HIV physician who is very experienced in HIV treatment and together with the primary care physician takes care of the patient. This is what is basically practised in our clinics.  So together with the physicians we try to look for cardio vascular disease problems, smoking cessation and such things.

What is also very important is the multiple co-medications which are involved, so the primary care physician and the HIV doctor have to know what kind of treatment the patient is undergoing. Here in Switzerland we have HIV specialists who are also family doctors but they are very familiar with HIV medicine.

swissinfo.ch: Did the study show that there are some diseases more prevalent in HIV+ patients than others?

B.H.: We tried to look at the cancer observatory in our country, this is the only reliable incidence data about cancer, and we found that in the disease group of the over 65 years, there is a hint that the incidence of cancer in our cohort is higher, but it is nothing too firm yet.

Study

8,444 (96%) of 8,848 participants contributed data from 40,720 semi-annual visits;

2,233 people were aged 50-64 years, and 450 were aged 65+ years;

The median duration of HIV infection was 15.4 years.

23.2% had prior clinical Aids.

994 incidents of non-Aids events were observed during the reference period (January 2008 to December 2010), including:

201 cases of bacterial pneumonia, 55 myocardial infarctions, 39 strokes, 70 cases of diabetes mellitus, 123 trauma-associated fractures, 37 fractures without adequate trauma, and 115 non-Aids malignancies.

Conclusions: Co-morbidity (secondary disease) and multi-co-morbidity (several concurrent diseases) because of non-Aids diseases, particularly diabetes mellitus, cardiovascular disease, non-Aids-defining malignancies and osteoporosis, become more important in care of HIV-infected persons and increase with age.