Living Longer with HIV: Watch for Metabolic Complications

Experts now classify infection with HIV as a chronic condition. People who become infected, regardless of their age, can expect to live long lives if they are adherent to antiretroviral (ARV) therapy. However, with that longer life expectancy comes a burden of other comorbid chronic disease.

Individuals with HIV are at 1.5-2 times the risk of cardiovascular disease and a disproportionate risk of death. HIV infection is frequently accompanied by high blood pressure, obesity, dyslipidemia, and diabetes. The astute reader will immediately associate these conditions with metabolic syndrome.

Researchers from George Washington University in Washington, DC, Cerner Corporation in Kansas City Missouri, and the National Institute of Allergy and Infectious Diseases in Bethesda, MD, recently conducted a study designed to look at the citywide prevalence of hypertension, type 2 diabetes, dyslipidemia, and obesity in individuals with HIV residing in Washington, DC. Their data, derived from the DC Cohort Study, included a racially diverse population of adults with HIV.

The researchers indicated that metabolic comorbidities create a persistent, pervasive burden for adults who have HIV. They also noted that their findings can be generalized to populations living in other urban cities.

Hypertension was common in this cohort, with half the patients affected. This was a higher prevalence than that identified in other large studies. As the patient's age increased, so did the likelihood of hypertension with 74% and 86% of patients aged 60-69 and older than 70 years, respectively, having hypertension.

Rates of diabetes were 12% and 19% for male and female patients respectively. Approximately half of male patients and 40% of females were diagnosed with dyslipidemia, rates higher than those previously reported in large studies.

Rates of smoking were very high with approximately half of patients reporting current cigarette use.

The researchers concluded that clinicians need to emphasize primary and secondary prevention of metabolic disease, and especially lifestyle modifications including smoking cessation. More work is needed to determine which interventions and specific medications work best in the patient with HIV who has metabolic complications.

Reference

Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A; DC Cohort Executive Committee. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med. 2017 May 15. doi: 10.1111/hiv.12516. [Epub ahead of print]