HIV-infected patients have increased risk of noncommunicable diseases (NCDs). HIV+ patients in Africa are experiencing growing comorbidities due to increase in life expectancy and long-time antiretroviral therapy (ART). HIV prevalence in Malawi is one of highest in the world (10.8% in women and 6.4% in men); few data are available about NCDs epidemiology in HIV+ elderly patients in Malawi.
A retrospective analysis of routine medical records in 14 health centers run by Disease Relief through Excellent and Advanced Means (DREAM) program in Malawi was carried out. All HIV+ patients aged >40 years in care in the period January 01, 2017–December 31, 2018 were included. Clinical and laboratory features were collected in the last visit of the study period.
Files from 7,071 patients (62.1% women) in ART were analyzed, 362 (5.1%) were aged >65 years. Median time on ART was 98.9 (64.8–118.0) months; median body mass index, haemoglobin (HB), and CD4 count were, respectively, 21.63 kg/m2 (19.5–24.5), 13 mg/dL (12–14), and 457 cell/mm3 (328–613). Elderly patients >65 years were more likely to be malnourished (odds ratio [OR] = 2.0, confidence interval [CI]: 1.54–2.59), diagnosed with arterial hypertension (OR = 2.5, CI: 1.94–3.43), affected with diabetes (OR = 2.7, CI: 1.25–6.22), have macrocytic anemia (OR = 2.5, CI: 2.00–3.35), and increased serum creatinine (OR = 1.5, CI: 1.03–2.43]). Other factors were associated with NCD burden, but age remained always independently related. Two concomitant chronic conditions in addition to HIV were present in 19.2% (66/343) of elderly people and 5.2% (338/6.454) of patients aged <65 years (OR = 4.3, CI: 3.22–5.76). Some associations were observed: nevirapine (NVP) was associated with kidney disease (OR = 1.5, CI: 1.22–2.06), NVP and protease inhibitor (PI) with hypertension (OR = 2.79, CI: 2.16–3.35 and OR = 2.15, CI: 1.52–3.02), azidothymidine (AZT) with macrocytic anemia (OR = 15.6, CI: 13.18–18.68). NVP, AZT, and duration of any ART >3 years were associated with the presence of two or more comorbidities (OR = 2.1 1.54–2.96, OR = 2.6 1.87–3.71, and OR = 1.7 1.12–2.84).
Our data show the burden of NCDs in aging HIV+ patients in Malawi. The expansion of HIV treatment programs will require special attention to such comorbidities in elderly patients.