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.

Details

Title
Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997–2019
Author
Morton, Zoey P 1 ; Mehta, C Christina 2 ; Wang, Tingyu 3 ; Palella, Frank J 4 ; Naggie, Susanna 5   VIAFID ORCID Logo  ; Golub, Elizabeth T 6 ; Anastos, Kathryn 7 ; French, Audrey L 8 ; Kassaye, Seble 9 ; Taylor, Tonya N 10 ; Fischl, Margaret A 11 ; Adimora, Adaora A 12 ; Kempf, Mirjam-Colette 13 ; Tien, Phyllis C 14 ; Ofotokun, Ighovwerha 2 ; Sheth, Anandi N 2   VIAFID ORCID Logo  ; Collins, Lauren F 2   VIAFID ORCID Logo 

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 
Publication year
2023
Publication date
Feb 2023
Publisher
Oxford University Press
e-ISSN
23288957
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1093/ofid/ofac702
ProQuest document ID
3170928629
Copyright
© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. This work is published under https://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.