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African Americans taking ART have high incidence of illness associated with risk of cardiovascular disease
Michael Carter, 2016-12-20 08:20:00
men and women receiving antiretroviral therapy (ART) have especially high rates
of health problems that can increase the long-term risk of cardiovascular
disease, investigators from the United States report in the online edition of Clinical Infectious Diseases. Incidence
of diabetes mellitus, chronic kidney disease and treated
hypertension were all higher among black people compared to other
racial groups. In addition, both black and white women had a higher incidence
of chronic kidney disease compared to some other groups.
disparities in the occurrence of HTN [hypertension], DM [diabetes mellitus], and CKD [chronic kidney disease] persisted among men and women
aging with HIV with access to care,” write the authors. “Our findings are a
call to action to: 1) better understand the drivers of these disparities that
persist in an environment with equal access to care….and 2) fill gaps in NCD
[non-communicable disease] prevention services among adults aging with HIV.”
Thanks to ART,
many people with HIV are now living well into old age and illnesses
associated with ageing – especially cardiovascular disease – are now an important
cause of serious illness and death among ART-treated older people living with HIV.
Prevention of disorders that are associated with an increased risk of
cardiovascular disease is now a priority of HIV care. However, it is unclear if
the risk of these for ageing-related diseases in HIV-positive people differs
according to sex and race.
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
therefore designed a study to estimate the incidence before the age of 70 years
of key non-HIV-related illness among people who received ART between 2000 and
2013. There were 20 cohorts providing data on diabetes mellitus, 22 cohorts on chronic kidney disease and 16 on treated hypertension.
Overall, around 51,000
people were included in the study; these people were followed for a median
of five years and contributed a total of 288,000 person-years of follow-up. The
majority (83%) were male, 44% were black and 84% were aged below 50 years. Two-thirds
of individuals started ART before 2006.
Half of the participants
had a viral load above 400 copies/ml and 44% had a CD4 count below 200 cells/mm3.
Rates of first
occurrence of each disease were:
- hypertension = 2.6 per 100
- diabetes mellitus = 1.2 per 100
- chronic kidney disease = 0.6
per 100 person-years.
Median age at
diagnosis was between 48 and 51 years.
After taking into
account age, risk group and HIV-related factors, the investigators found
significant disparities in the risk of these outcomes according to sex and
regardless of sex, was associated with increased rates of hypertension (black
women, aIRR = 1.8; 95% CI, 1.6-2.1; black men, aIRR = 1.5; 95% CI, 1.4-1.7).
non-black men, black women (aIRR = 1.4; 95% CI, 1.2-1.6), black men (aIRR =
2.0; 95% CI, 1.6-2.3) and non-black women (aIRR = 1.4; 95% CI, 1.2-1.7) all had
increased incidence of diabetes mellitus.
comprising only 12% of the US population, blacks have a disproportionate burden
of HIV infection,” note the investigators. “The confluence of this burden of
HIV infection and the associations of race with NCDs indicates an important
clinical and public health issue.”
Women – black and
non-black – had significantly higher rates of chronic kidney disease compared
to non-black men (aIRR = 1.5; 95% CI, 1.2-19 and 1.5; 95% CI, 1.1-2.0,
“In the setting of
HIV infection, reasons for sex disparities are likely multifactorial, and may
include biological differences, and differences in care retention,” suggest the
authors. “In light of this, women aging with HIV may require approaches to care
that are distinct from those routinely used for men in terms of devising
effective prevention and treatment plans for NCDs.”
disparities persisted after adjustment for body mass index (BMI).
incidence (by age 70) according to race-sex ranged from 51 to 73% for
hypertension, 34 to 52% for diabetes mellitus, and 25 to 38% for chronic
increased rates of HTN, DM, and CKD, especially among HIV-infected black men
and women,” conclude the researchers. “Minimizing sex-race health disparities
through more proactive preventive care, such as smoking cessation, physical
activity, and nutritional assistance programs, will shape the quality of
extended life made possible by effective ART in this population engaged in