Invecchiare con la terapia antiretrovirale o essere anziani in terapia antiretrovirale: due profili di comorbidità differenti?

In Persons Living With HIV (PLWH), the burden of non-communicable chronic diseases increased over time, because of aging linked to prolonged survival, chronic inflammation, systemic immune activation, and long-term exposure to the combination antiretroviral therapy (ART). Chronological age, age at HIV diagnosis, and exposure to ART may exert an effect on qualitative and quantitative differences. To explore this hypothesis, we evaluated the prevalence of some selected comorbidities in patients enrolled in the SCOLTA Project, by groups of chronological age (50- 59 and ≥60 years old) and ART duration. In 1336 subjects (23.9% women), ART duration was similar between age groups, both when considered in continuous (p=0.85) and in categories (p=0.88). As expected, comorbidities and multimorbidity were less frequent in the 50-59 than in the ≥60 years class. The age- and sex-adjusted odds ratios (ORs) showed that, in the 50-59 years group, a consistent and significant risk increase was observed through ART duration categories for CVD (ORs from 1.68 to 2.18), dyslipidemia (ORs from 3.61 to 9.08) and osteopenia/osteoporosis (ORs from 3.74 to 6.23). Consequently, the risk of multimorbidity also increased across ART duration categories (ORs from 2.04 to 4.40). In the ≥60 years group, the CVD risk was significantly increased only in those patients with ART duration ≥20 years (OR 2.61, 95% CI 1.22-5.58, reference category ≤6 months). Dyslipidemia and multimorbidity increase were consistently associated with longer ART duration. In conclusion, age, age at HIV infection diagnosis, and ART exposure were associated to multimorbidity in PLWH.