Title

Beyond the 60s: Changing co-morbidities in people living with HIV aged over 60 attending clinic in 2010 and 2017

Presenter

Ming Jie Lee

Authors

M.J. Lee¹, J. Bilinska¹, E. Wallis¹, L. Campbell¹, R. Patel², C. Smith³, C. Williams¹, H. Iveson⁴, R. Kulasegaram¹

Institutions

¹Guy's and St Thomas Hospital NHS Foundation Trust, Harrison Wing, Department of HIV, London, United Kingdom, ²St George's University London, London, United Kingdom, ³University College London, Institute of Epidemiology and Health Care, London, United Kingdom, ⁴Salisbury NHS Foundation Trust, Salisbury, United Kingdom

Background: People living with HIV (PLHIV) are increasingly living longer due to effective antiretroviral (ARV) therapy. We characterised and compared within clinic cohorts across two time points, the prevalence of co-morbidities in PLHIV aged over 60s (PLHIV60s) attending a London HIV clinic.
Methods: The cohorts included all PLHIV60s under regular follow-up in December 2010 and September 2017. Demographics, ARV history, co-morbidities, and investigation results were included.
Results: A greater proportion of the clinic population were aged over 60 in 2017 (300/3299, 9.1%) than in 2010 (126/2700, 4.7%). 85 (67.5%) patients under follow-up in 2010 remained so in 2017, 7 were lost to follow up (5.6%), 13 transferred care (10.3%), and 21 died (16.7%). Causes of death include malignancy (8/14), HIV-related complications (3/14), sepsis (2/14), and motor neurone disease (1/14). Median age, gender, ethnicity, and sexual orientation was similar in both cohorts. Age range was 60-83 in 2010 and 60-90 in 2017.
299/300 (99.7%) were on ARVs in 2017, and 119/126(94%) in 2010. Currently, 285/299 (95.3%) remain virally suppressed (< 200copies/ml). Median baseline CD4 count were similar (189 vs 222cells/µL, p=0.19).
Prevalence of co-morbidities are summarised in Table 1.

Co-morbidities	2010 (n=126)		2017 (n=300)		p-value
Ischaemic heart disease	22	17.5%	28	9.3%	0.0211
Chronic kidney disease stage 3 or worse (CKD3+)	20	15.9%	91	30.3%	0.0016
Osteopaenia/osteoporosis	27	21.4%	110	36.7%	0.0021
Hypercholesterolaemia	65	51.6%	171	57.0%	0.3369
Diabetes Melitus (Type 1 or 2)	14	11.1%	42	14.0%	0.5299
Hypertension	-	-	132	44.0%	-
Heart Failure (Left ventricular ejection fraction <55%)	-	-	12	4.0%	-
Malignancy	-	-	50	16.7%	-
>3 of above co-morbidities	28	22.2%	92	30.7%	0.077

[Table 1]

In 2017, mean duration of TDF exposure in patients with or without CKD3+ was 65 vs 80 months (p=0.035). TDF exposure was associated with CKD3+ (OR=1.0046 per month longer, 95%CI 1.0003 - 1.0090, p=0.034), and a trend remained after adjusting for age, ethnicity, diabetes and hypertension (p=0.089).
169/300 (58.9%) had a body mass index ≥25. Of those with liver transient elastography results, 20/49(40.8%) had evidence of fatty liver (CAP>280).
29% (50/272) were on ≥ 5 concomitant drugs. 155/272 (57.0%) had at least 1 drug-drug interactions (DDI). Older age was associated with increasing concomitant drugs (r=0.13, p=0.03) and DDIs (r=0.15, p=0.01).
Conclusions: The proportion of PLHIV60s in our cohort has doubled over 7 years. Fatty liver disease, renal dysfunction, and osteopenia/osteoporosis are increasingly diagnosed in PLHIV60s, likely reflecting improved monitoring in line with updated national guidelines. Multiple co-morbidities, polypharmacy and DDIs were common in PLHIV60s. Reviewing ARVs regularly is essential to optimise co-morbidities and quality of life of PLHIV as life expectancies continue to improve.

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