Doi.org/10.57594/1049
Bonilla Sánchez-Gabriela Alejandra1, Berrospe Silva-María de los Ángeles2 Farías Moreno-Katia1, Ferrel Escobar-Cristopher1, Mata-Marín José Antonio3
1. Geriatric Department, Hospital General Regional 45 del Instituto Mexicano del Seguro Social Guadalajara, Jalisco. Mexico.
2. Infectious Diseases Department, Hospital General Regional 45 del Instituto Mexicano del Seguro Social Guadalajara, Jalisco. Mexico.
3. Infectious Diseases Department, Hospital de Infectología “Dr. Daniel Méndez Hernández” La Raza National Medical Center, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
Corresponding author: Gabriela Alejandra Bonilla Sánchez. Hospital General de Zona 26, del Instituto Mexicano del Seguro Social, 20 Simón Bolivar Street, Tala, Jalisco, Mexico. CP 45300. Email: geriatrabonilla@gmail.com
ABSTRACT:
Background: The increase in life expectancy worldwide, greater access to health services, improvements in treatments and decrease in mortality lead to the aging of HIV-infected subjects with comorbidities. In people with HIV infection, the World Health Organization considers an older adult to be equal or older than 50 years of age, as opposed to an older adult without this condition.
Methods: This study was conducted on patients diagnosed with HIV infection at the Infectious Diseases Department of Hospital General Regional (HGR) 45, IMSS. Medical records from the period 2019-2022 were reviewed. Participants were categorized into two groups: young adults (<50 years) and older adults (≥50 years). Comorbidity was defined as the presence of two or more chronic diseases. The study considered age, gender, recent diagnosis, and duration of HIV infection as intervening variables.
Results: 77 adults with human immunodeficiency virus (HIV) infection from Infectious Disease outpatient clinic of the Regional General Hospital 45 IMSS, Guadalajara, Jalisco were studied. The average age was 39.9±11.5 years with an interval between 20 to 71 years. Age distribution showed a 29.9% (n=23) of older adults (≥50 years), with an average age of 54.4±4.6 years. We found the presence of comorbidities on 34.7% of young adults (n = 8) and in 9.2% (n = 5) of older adults (> 50 years). The most common comorbidities were liver cirrhosis (30.8%), dyslipidemia (30.8%), systemic arterial hypertension (23.1%), type 2 diabetes mellitus, depression and hypothyroidism with 7.7% each one.
Conclusions: The most frequent comorbidities on our population were dyslipidemia and liver cirrhosis, with no difference between young or older adults. The finding of liver cirrhosis as one of the main comorbidities in our population contrasts with previous reports. The origin of this increased frequency needs to be further evaluated.
BACKGROUND:
The increase in life expectancy worldwide, greater access to health services, improvements in treatments and decrease in mortality lead to the aging of HIV-infected subjects with comorbidities. In people with HIV infection, the World Health Organization considers an older adult to be equal or older than 50 years of age, as opposed to an older adult without this condition. In longitudinal studies, comorbidities have been found to be more common in older adults with HIV compared to younger adults with HIV infection. (1,2)
There is increasing scientific evidence suggesting that the HIV-infected population experiences early immunological changes similar to those that cause aging in the general population. These immunological changes occur mainly as a consequence of a basal state of immune activation and persistent inflammation that is independent of adequate virological control, and that gradually lead the immune system to a situation of premature aging that we call immunosenescence. (2,3)
The clinical translation of this immunosenescence is the appearance of age-related comorbidities such as diabetes, cardiovascular disease, neoplasia, or cognitive impairment, in addition to functional impairment, frailty, and geriatric syndromes, all of which appear a decade earlier and twice as prevalent in older adults with HIV compared to the general population, therefore, evidence of a worse and slower immune response to ART, together with the presence of early immunosenescence that leads to a prematurely eliminated effect on physiological functions. (4,5,6)
The number of adults aged 50 years or older living with HIV is increasing globally, which naturally leads to an increase in the prevalence of HIV comorbidities. This increase is mainly due to earlier initiation of ART compared to the pre-test and treat era, which improved the survival chances of HIV-infected populations. The resulting longer duration of exposure to ART has also been linked to an increased risk of hypertension, cardiovascular disease, malignancies, osteoporosis, cognitive impairment, frailty and disability. (7,8)
The clinical perspective of multimorbidity can be determined by several factors, in addition to a change in the age composition towards older people. (9) As previously mentioned, older HIV patients often have several comorbidities, which is why it is useful to have a “comorbidity instrument”, said instrument is called the reduction of diseases and their severity in a person to a score that allows their comparison with others. Among these instruments we have the Charlson index, which is the most frequently used instrument in the prognostic evolution of patients with comorbidity, including AIDS as one of these comorbidities. (10)
Objective: Describe the frequency of comorbidities on the patients with HIV infection at the Infectous Diseases Department of the Hospital General Regional (HGR) 45 IMSS.
MATERIAL AND METHODS: This study was conducted on patients diagnosed with HIV infection at the Infectious Diseases Department of Hospital General Regional (HGR) 45, IMSS. Medical records from the period 2019-2022 were reviewed. Participants were categorized into two groups: young adults (<50 years) and older adults (≥50 years). Comorbidity was defined as the presence of two or more chronic diseases. The study considered age, gender, recent diagnosis, and duration of HIV infection as intervening variables.
Inclusion criteria: diagnosed with HIV infection, evaluated two or more times in the outpatient clinic over a period of 12 months or more
Exclusion criteria: lack of adherence or refusal to follow the prescribed treatment, incomplete data, parametric descriptive and inferential statistics, including Student’s t-test for independent variables, were utilized. The signature of informed consent was omitted. The research project was submitted to and approved by the local bioethics committee of HGR 45.
Study population: Young and older adults with HIV infection diagnosis belonging to the Infectious Diseases department of the Hospital General Regional #45 of Instituto Mexicano del Seguro Social on Guadalajara, Mexico.
Statistical analysis: The statistical programs Microsoft Excel, Epiinfo7 and SPSS V24 were used for database, sample calculation and data analysis, respectively. For data analysis, descriptive statistics were used based on measures of central tendency (mean, median and mode) and dispersion (standard deviation and variance) and inferential statistics according to data distribution. For the comparison of quantitative variables, one-way ANOVA and Kruskal-Wallis were used for parametric and non-parametric distribution, respectively. For qualitative variables, the X2 test with Yates correction was used.
RESULTS: 77 adults with human immunodeficiency virus (HIV) infection from Infectious Disease outpatient clinic of the Regional General Hospital 45 IMSS, Guadalajara, Jalisco were studied. The average age was 39.9±11.5 years with an interval between 20 to 71 years. The gender distribution showed a male predominance of 90.9% (n=70). Age distribution showed a 29.9% (n=23) of older adults (≥50 years), with an average age of 54.4±4.6 years. We found the presence of comorbidities on 34.7% of young adults (n = 8) and in 9.2% (n = 5) of older adults (> 50 years). The most common comorbidities were liver cirrhosis (30.8%), dyslipidemia (30.8%), systemic arterial hypertension (23.1%), type 2 diabetes mellitus, depression and hypothyroidism with 7.7% each one. (See Figure 1). Older adults with human immunodeficiency virus (HIV) infection diagnosis had a higher frequency of comorbidity with an OR 5.2 (1.4-18.3) (p<0.001)
Figure 1. Distribution of adults with HIV infection according to age:
Calculated using proportions.
Table 1. Comparison of CD4+ T lymphocyte means according to age:
| Category | CD4+ T lymphocyte | p |
| Young adult | 315.9±250.1 | 0.4 |
| Elderly | 362.6±247 |
Calculated using Student’s t for independent samples.
DISCUSSION:
Was previously published that patients with HIV infection have more prevalence of comorbidities when are compared with general population, intervening premature aging, adverse effects of ARV and biological effects of HIV infection. A growing number of HIV infection patient above 50 years become relevant, because it’s not enough scientific evidence about their comorbidities and the best way to manage him.
The most frequent comorbidities on our population were dyslipidemia and liver cirrhosis, with no difference between young or older adults. Our findings on cardiovascular comorbidities (dyslipidemia and arterial hypertension) were previously reported on literature, but the finding of liver cirrhosis as one of the main comorbidities in our population contrasts with previous reports. The origin of this increased frequency needs to be further evaluated.
The CD4+ T lymphocyte count was compared between young adults and older adults with HIV in the population of the Regional General Hospital 45 IMSS Jalisco, without statistically significant difference.
Figure 2. Frequency of comorbidities in adults with HIV:
| Hepatic C | Dyslipidemia | HAS | DM2 | Depresion | HT | |
| Series1 | 30.8% | 30.8% | 23.1% | 7.7% | 7.7% | 7.7% |
Hepatic C= hepatic cirrhosis, HAS= systemic arterial hypertension, DM2= diabetes mellitus type 2, HT= hypothyroidism. Calculated using proportions.
Tabla 2. Comparison of comorbidity frequency by age:
| Category | Comorbidity | No comorbidity | p |
| Young adult | 34.7 % (n=8) | 65.3% (n=15) | <0.001 |
| Elderly | 9.2% (n=5) | 90.7% (n=49) |
Calculated using Student’s t for independent samples.
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