Italian study shows growth in heart and kidney problems in people living with HIV

By | December 31, 2018

The closed cohort consisted of individuals who were seen for care both in 2004 and 2014. By definition, each participant was ten years older in 2014, therefore the prevalence of non-communicable diseases would be expected to increase, but not by as much as was observed.

It consisted of 1517 people (33% women) with a median age of 41 years in 2004 and 51 years in 2014. By 2014, 13% of the cohort were aged 61 or over. Forty-three per cent had acquired HIV through injecting drug use, 23% by heterosexual contact and 27% were men who have sex with men.

In 2004, 21% were not taking ART but by 2014 only 2% were not on treatment. The median CD4 cell count in the cohort rose from 507 to 706 cells/mm3 and by 2014, 92% had a CD4 cell count above 350 cells/ mm3.

The prevalence of obesity, measured by body mass index, did not increase significantly. The prevalence of smoking declined from 55% to 46%, a significant reduction (p < 0.001). However, alcohol consumption increased: in 2004, 34% of the cohort reported no alcohol use, falling to 19% in 2014 (p < 0.001).

The prevalence of hepatitis C in the cohort was high: 33% had the virus in 2014 and 5% were hepatitis B surface antigen positive.

Several co-morbidities increased in prevalence between 2004 and 2014. Whereas 5% had impaired kidney function in 2004 (defined as eGFR < 60ml/min), almost a third (30%) had impaired kidney function (p < 0.001) in 2014.

In 2004, 18% of the cohort had cardiovascular disease, defined as a heart attack, stroke or invasive coronary procedure occurring at least one year prior to 2004. By 2014 almost a third of the cohort had a history of cardiovascular disease (32%), a very high burden of cardiovascular disease in a cohort with a median age of 51 years.

The proportion of people at high risk of a cardiovascular event within the next five or ten years also increased sharply. In 2004, 20% were at high risk of a cardiovascular event within five years (> 10% risk) using the D:A:D scoring system. By 2014, 50% were at high risk (p < 0.001).

The prevalence of dyslipidaemia (at least one of total cholesterol > 6.2mmol/l, HDL cholesterol > 0.9mmol/l or triglycerides > 2.3mmol/l in the previous year) rose from 75% in 2004 to 91% in 2014. The prevalence of hypertension rose from 67% to 84% between 2004 and 2014 (p < 0.001).

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