New diagnoses of HIV have decreased, though, as care and management improve, the overall number of people living with HIV (PLWH) has increased. Due to complex reasons, PLWH may have a higher burden and/or a higher risk of developing other chronic conditions compared to people without HIV. These reasons include the exposure to toxic drugs, consistent inflammation, and immune activation despite being on effective medication, traditional risk factors such as smoking and physical inactivity, HIV-related stigma and other psychosocial factors. However, these factors change over time and may have impacted the burden and risk of PLWH developing other conditions in the last 20 years. Living with multiple chronic conditions can negatively impact quality of life, patient safety, and clinical outcomes. It is therefore important to understand the current burden of common conditions that PLWH develop and how their risk compares to people without HIV to ensure services are optimally designed for providing specialised care to PLWH and reduce premature mortality.
We will investigate the burden, risk and trends of various conditions including high blood pressure, depression, anxiety, severe mental illness, all-cause hospitalisation and mortality, and cause-specific hospitalisation and mortality among PLWH from 2001 to 2022. These findings will provide healthcare providers and policy makers with evidence on which conditions PLWH are at higher risk for, which occur most frequently, and which are related to healthcare utilisation (hospitalisation) and death. Thus, these results will be imperative for adapting health services to prevent and improve care for common co-existing conditions among PLWH.
People living with HIV (PLWH) experience persistent inflammation and immune response and toxicity from antiretroviral therapy (ART); these mechanisms combined with increased prevalence of behavioural and psychosocial risk factors may contribute to a higher burden of non-communicable diseases (NCDs) among PLWH. In turn, PLWH may have worse clinical outcomes and more healthcare utilisation compared to people without HIV. The aim of this study is to compare prevalence, incidence, risk and trends of various NCDs and all-cause and cause-specific hospitalisation and mortality in PLWH with people without HIV.
From 1st January 2001 to 31st December 2022, we will calculate the prevalence, incidence, risk and trends of hypertension, diabetes, anaemia, depression, anxiety, self-harm, attempted suicide, schizophrenia, bipolar disorder among PLWH aged 15 or older and compare these findings to people without HIV using data from CPRD Aurum. We will also look at prevalence, incidence, risk and trends of cause-specific hospitalisation and mortality among PLWH compared to matched people without HIV, using linked data from Hospital Episode Statistics and Office for National Statistics, respectively; these outcomes will be categorised using ICD-10 chapters with an additional category created for AIDS-related causes.
Overall prevalence and incidence will be calculated over the 22-year study period and annually for trends. A Cox proportional hazards regression will be used to calculate risk of each outcome between PLWH and people without HIV matched by age, sex, ethnicity, and geographical location.
The results to this research have the potential to provide high quality evidence that could have implications on healthcare delivery, clinical practice and prevention strategies for PLWH, particularly given the changes made to ART over the last 20 years. The findings can and should inform ways to prevent NCD comorbidities, hospitalisation and premature mortality among PLWH; thus, improving PLWH quality of life, and reducing healthcare costs.
- Overall prevalence and incidence of hypertension, diabetes, anaemia, depression, anxiety, self-harm, attempted suicide, schizophrenia, bipolar disorder, all-cause and cause-specific hospitalisation and mortality among PLWH and separately for people without HIV.
- Annual trends of prevalence and incidence of hypertension, diabetes, anaemia, depression, anxiety, self-harm, attempted suicide, schizophrenia, bipolar disorder, all-cause and cause-specific hospitalisation and mortality among PLWH and separately for people without HIV.
- Risk of hypertension, diabetes, anaemia, depression, anxiety, self-harm, attempted suicide, schizophrenia, bipolar disorder, all-cause and cause-specific hospitalisation and mortality in PLWH compared to people without HIV.
Tiffany Gooden - Chief Investigator - University of Birmingham
Tiffany Gooden - Corresponding Applicant - University of Birmingham
G. Neil Thomas - Collaborator - University of Birmingham
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation