Non-communicable diseases double among older people living with HIV in Latin America

The prevalence of non-communicable diseases (NCDs), such as diabetes and liver disease, has more than doubled in the last 15 years among over 50-year-olds receiving HIV care in Latin America.

Around a quarter of people in HIV care in the region are above 50, but before this study little was known about the frequency of other illnesses among this group. These findings suggest that complex care for those aging with HIV in Latin America will be increasingly needed.

Researchers followed 3,415 people aged 50 or older in HIV care between 2000 and 2015 at six centers in Argentina, Brazil, Chile, Honduras and Mexico. Participants, who were followed for 3.7 years on average, were monitored for cardiovascular diseases, diabetes, hypertension, dyslipidemia (such as high cholesterol), psychiatric disorders, chronic liver and renal diseases, and non-AIDS-defining cancers.

Just under half of participants (43%) had enrolled in HIV care after the age of 50 while the remainder had begun treatment when younger. Researchers made this distinction in order to compare the difference between those aging with HIV and those diagnosed at an older age.

Between 2000 and 2015, the annual prevalence of NCDs more than doubled among those 50-plus, increasing from 32% to 68%. In 2015, 40% of over 50s had more than one NCD, compared to 30% in 2000, regardless of the age they began HIV care.

Three of the four most common NCDs found increased cardiovascular risk. These were dyslipidemia (abnormal amounts of lipids in the blood, affecting 36% those who had enrolled in care before the age of 50 and 28% of those who enrolled at 50-plus), hypertension (17% vs. 18%), and diabetes (11% vs. 12%). Psychiatric disorders were also common, affecting 15% of those in care before the age of 50 and 10% of those who were 50 or older before starting treatment.

Those enrolled in care after the age of 50 were found to have a lower prevalence of NCDs than those who reached 50 while in care. However, those enrolled in care at an older age had a higher incidence (new infection rate) of NCDs than those who had been on ART for longer.

Interestingly, there was a lower NCD prevalence among all participants compared to the general population in Latin America. The prevalence of diabetes, non-AIDS-defining cancer, psychiatric disorders, hypertension, and cardiovascular, renal, and liver diseases in the overall study cohort was also lower than that found among older people living with HIV in studies in high-income countries. Differences in environmental, genetic and individual risk factors for NCDs might explain these differences.

The study is limited by a number of factors. It did not examine other relevant NCD risk factors, such as diet, physical activity, body composition or tobacco use. Nor did it take into consideration disability, poly-pharmacy (the effects of taking multiple medications) and dementia, which might be more relevant to the health-related quality of life and healthcare needs of people living with HIV as they age.