Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997–2019

BACKGROUND: To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997–2019). MET...

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Detalles Bibliográficos
Autores principales: Morton, Zoey P, Christina Mehta, C, Wang, Tingyu, Palella, Frank J, Naggie, Susanna, Golub, Elizabeth T, Anastos, Kathryn, French, Audrey L, Kassaye, Seble, Taylor, Tonya N, Fischl, Margaret A, Adimora, Adaora A, Kempf, Mirjam-Colette, Tien, Phyllis C, Ofotokun, Ighovwerha, Sheth, Anandi N, Collins, Lauren F
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Major Article
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9897021/
https://www.ncbi.nlm.nih.gov/pubmed/36751648
http://dx.doi.org/10.1093/ofid/ofac702
Descripción
Sumario:BACKGROUND: To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997–2019). METHODS: We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc). RESULTS: Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1–Q3, 7–23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm(3). Median time-updated cumulative VCY was 5.4 (Q1–Q3, 4.7–6.9) log(10) copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log(10), the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29–3.08) and 3.78 (95% CI, 2.17–6.58) for those with VCY 5–6.9 and ≥7 log(10) copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM. CONCLUSIONS: Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population.

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