Photo Credit: Andrey Popov

By age 30, up to 50% of patients with perinatally acquired HIV will have at least one comorbidity, indicating a need for earlier screening and treatment in this group.

This is the first in a two-part series on comorbidities in patients with HIV. In Part One, Nel Jason L. Haw, PhD, MHS, MS, discussed comorbidities in patients with perinatally acquired HIV.

“People with perinatally acquired HIV (PHIV) have unique circumstances compared with people with non-perinatally acquired HIV. A 30-year-old with PHIV will have the same duration of HIV and ART use as a 50-year-old who acquired HIV at age 20,” Nel Jason L. Haw, PhD, MHS, MS, notes. “There are many studies that have described the potential mechanism of HIV acquisition or ART use on chronic comorbidities among older individuals with HIV, and we suspect that something similar may be occurring among younger individuals with PHIV who have a similar duration of HIV acquisition or ART use.”

The need for research on this topic was two-fold, according to Dr. Haw. “We wanted to shed light on the experiences of people with PHIV at the population level and contribute to the ongoing discourse on the natural history and HIV-related mechanisms of chronic conditions. There’s also the aspect of timing. Most patients with PHIV in North America were born in the late 1980s/early 1990s before interventions that interrupted vertical transmission were introduced, so we can only study their adult outcomes today.”

For a study published in AIDS, Dr. Haw and colleagues examined the incidence of type 2 diabetes, hypercholesterolemia, hypertriglyceridemia, hypertension, and chronic kidney disease among 375 adults with PHIV aged 18-30.

Physician’s Weekly (PW) spoke with Dr. Haw to learn more.

PW: Can you elaborate on the finding that the number of people with PHIV increased by 14% from 2010 to 2019?

Dr. Haw: People with PHIV in North America comprise less than 1% of all people with HIV, so only a few of them, if at all, are included in HIV cohorts in this region. For us to be able to study adult outcomes among people with PHIV, adult HIV cohort studies must specifically recruit people with PHIV or must be able to follow children with HIV until adulthood. Very few HIV cohort studies can do this globally, so that’s partly the reason why we know little about the experience of adults with PHIV.

We wanted to emphasize the increase in the prevalence of PHIV to show that more and more people with PHIV are surviving through adulthood and that there is a need to describe what happens to people with PHIV in adulthood as more of them need high-quality care beyond childhood and adolescence.

What did you aim to determine with this study?

We wanted to shed light on the experiences of adult PHIV, an understudied population in HIV research, as they have unique circumstances. We wanted to demonstrate that these unique circumstances correspond to unique health needs not currently considered in HIV clinical guidelines. We leveraged the “cohort of cohorts” approach of The North American AIDS Cohort Collaboration on Research and Design, or NA-ACCORD, to be able to pool people with PHIV from more than a dozen HIV cohort studies.

What are the relevant findings for US clinicians?

We found that, by age 30, about one in five people with PHIV will have type 2 diabetes, two in five will have hypercholesterolemia, one in two will have hypertriglyceridemia, one in four will have hypertension, and one in four will have chronic kidney disease.

We want clinicians who care for people with PHIV to be more mindful in screening for chronic comorbidities, especially at the point when people with PHIV transition from pediatric to adult care. Current HIV screening guidelines for chronic comorbidities consider screening at a much older age (around age 40), but our findings show that screening should occur much earlier than 40.

To that end, we found that approximately one in five people with PHIV have developed hypercholesterolemia and hypertriglyceridemia before transitioning to adult HIV care. We suspect that this may have something to do with long-term ART use.

Did you identify any disparities in the incidence of comorbidities?

We did, as we also reported on incidence by sex and race. Across sex and race groups, Non-Black women had the highest incidence of hypercholesterolemia and hypertriglyceridemia, Black adults had the highest hypertension incidence, and Black men had the highest incidence of chronic kidney disease.

What would you like future research to focus on?

I want to work with cohorts that have more granularity on the ART experience of people with PHIV to see if duration of exposure to specific ART regimens contributes to the incidence of these chronic comorbidities. I also want to explore how other, more traditional risk factors, like smoking, affect incidence to guide clinicians on how to better target interventions for prevention and management.

Look for more from Dr. Haw coming soon, where he’ll discuss non-AIDS-related comorbidities and mortality among patients with HIV who were diagnosed in the 1980s and 1990s and are now reaching middle age.