HIV, Aging, and Comorbidities Research in Clinical Cohorts: 3 Lessons Learned Using Examples From the CNICS Cohort
Year: 2022
Type: article
Abstract: BACKGROUND: Owing to ongoing improvements in antiretroviral therapy, people with HIV (PWH) are achieving near-normal lifespans with many surviving into middle and old age. Despite this success, PWH have a higher than expected risk of developing non-AIDS comorbidities, multimorbidity, and functional decline at ages younger than those without HIV. METHODS: As part of the Inter-CFAR (Center for AIDS Research) Symposium, HIV and Aging in the era of Antiretroviral Therapy and COVID-19, we presented a research update from HIV clinical cohorts and specifically described 3 lessons learned from the Centers for AIDS Research Network of Integrated Clinical Systems cohort that are important for HIV and aging research moving forward. RESULTS: Adjudicated outcomes are particularly beneficial for less common comorbidities such as myocardial infarction. Multiple ascertainment approaches increase sensitivity over using diagnoses alone (89% vs. 44%). Adjudication eliminates false-positive events and allows myocardial infarction types to be identified. Comorbidity research has often relied on composite outcomes, such as all cardiovascular diseases, often to increase power. Mechanistic differences across outcomes demonstrate the importance of moving away from many composite outcomes. Timely data are needed to ensure findings are relevant to improve care or outcomes for the population of PWH who are currently aging. CONCLUSIONS: A better understanding of the causes, mechanisms, prevention and treatment of functional decline, comorbidities, and multimorbidities is a crucial research focus as PWH are aging. Clinical cohorts with timely, comprehensive harmonized clinical data and carefully adjudicated outcomes are ideally positioned to improve understanding of these questions.
Authors: Heidi M. Crane, Lydia Drumright
Institution: University of Washington
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Genes, substance use, and HIV outcomes in people living with HIV across the US, 3/4 Alcohol Research Consortium in HIV - Epidemiological Research Arm (ARCH-ERA), Effectiveness of a smoking cessation algorithm integrated into HIV primary care, 1/3 Alcohol Research Consortium in HIV - Administrative Core (ARCH-AC), 3/3 Alcohol Research Consortium in HIV - Intervention Research Arm (ARCH-IRA), University of Washington/Fred Hutch Center for AIDS Research, The Johns Hopkins Center for AIDS Research (JHU CFAR), CFAR Network of Integrated Clinical Systems (CNICS), AIDS and Aging Research Platform (AARP), Links between Cardiovascular disease, Lung disease, and Obstructive sleep apnea in HIV: Understanding complex patients, The University of North Carolina Center for AIDS Research, UAB Center for AIDS Research (CFAR)
OpenAlex ID: W4205718094