ArticlesTime trends for risk of severe age-related diseases in individuals with and without HIV infection in Denmark: a nationwide population-based cohort study
Introduction
HIV-infected individuals are at increased risk of several age-related diseases including myocardial infarction,1 stroke,2 some non-AIDS associated cancers,3 severe neurocognitive disease,4 chronic kidney disease,5 chronic liver disease,6 and osteoporotic fractures.7 Despite the protective effects of highly active antiretroviral therapy (ART), HIV might have a detrimental effect on the risk of these diseases partly as a result of HIV-induced chronic immune activation, persistent low-grade inflammation, and potentially accelerated ageing.8 Consequently, risks of severe age-related diseases might increase not only with age, but also with duration of HIV and ART, and with later calendar years independent of age.
In this study, we used a nationwide population-based cohort of HIV-infected individuals and a comparison cohort from the general population to estimate time trends in the risk of nine serious age-related diseases that are highly prevalent in people with HIV.
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Study design and participants
As of Jan 1, 2014, Denmark had a population of 5·6 million, with an estimated HIV prevalence of 0·1% in adults. Treatment of HIV is restricted to eight specialised centres, in which patients are seen on an outpatient basis every 12–24 weeks. Health care in Denmark is tax-supported and antiretroviral treatment is provided free of charge. ART is prescribed according to national guidelines.9
The primary data source for our study was the Danish HIV Cohort Study (DHCS), which is a nationwide,
Results
6174 HIV-infected individuals met inclusion criteria; the proportion older than 50 years increased from 13% (276 of 2202) in 1995 to 43% (1791 of 4190) in 2014 (figure 1). 277 HIV-infected individuals were excluded because of a diagnosis of age-related disease before the date of inclusion, leaving 5897 HIV-infected individuals and 53 073 controls in the study. The median age of the HIV-infected individuals and control cohorts was 36·8 years and 76% were men (table).
Depending on the disease
Discussion
In this study, we noted that age-standardised and relative risks of cardiovascular diseases, cancers, and severe neurocognitive disease in Danish HIV-infected individuals did not increase with time after HIV diagnosis or ART initiation. Although the age-standardised risk of chronic kidney disease increased with time after ART initiation, no substantial increase was noted with time after HIV diagnosis. The opposite was noted for risk of chronic liver disease, whereas the age-standardised and
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