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

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

Published:2022-12-28 Issue:2 Volume:10 Page:
ISSN:2328-8957
Container-title:Open Forum Infectious Diseases
language:en
Short-container-title:

Author:

Morton Zoey P¹,Christina Mehta C²,Wang Tingyu³,Palella Frank J⁴,Naggie Susanna⁵^ORCID,Golub Elizabeth T⁶,Anastos Kathryn⁷,French Audrey L⁸,Kassaye Seble⁹,Taylor Tonya N¹⁰,Fischl Margaret A¹¹,Adimora Adaora A¹²,Kempf Mirjam-Colette¹³,Tien Phyllis C¹⁴¹⁵,Ofotokun Ighovwerha²¹⁶,Sheth Anandi N²¹⁶^ORCID,Collins Lauren F²¹⁶^ORCID

Affiliation:

1. Emory University School of Medicine , Atlanta, Georgia , USA

2. Division of Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia , USA

3. Emory University Rollins School of Public Health , Atlanta, Georgia , USA

4. Division of Infectious Diseases, Northwestern University, Feinberg School of Medicine , Chicago, Illinois , USA

5. Division of Infectious Diseases, Duke University School of Medicine , Durham, North Carolina , USA

6. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland , USA

7. Department of Medicine, Albert Einstein College of Medicine , Bronx, New York , USA

8. Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County , Chicago, Illinois , USA

9. Georgetown University Medical Center , Washington, District of Columbia , USA

10. SUNY Downstate Health Sciences University , Brooklyn, New York , USA

11. Division of Infectious Diseases, University of Miami Miller School of Medicine , Miami, Florida , USA

12. Gillings School of Global Public Health and the School of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA

13. Schools of Nursing, Public Health and Medicine, University of Alabama at Birmingham , Birmingham, Alabama , USA

14. Division of Infectious Diseases, University of California, San Francisco , San Francisco, California , USA

15. Medical Service, Department of Veterans Affairs , San Francisco, California , USA

16. Ponce de Leon Center, Grady Health System , Atlanta, Georgia , USA

Abstract

Abstract 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/mm3. Median time-updated cumulative VCY was 5.4 (Q1–Q3, 4.7–6.9) log10 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 log10, 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 log10 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.

Funder

MWCCS

Atlanta CRS

Baltimore CRS

Bronx CRS

Brooklyn CRS

Data Analysis and Coordination Center

Chicago-Cook County CRS

Chicago-Northwestern CRS

Northern California CRS

Metropolitan Washington CRS

Miami CRS