Health outcomes in aging women differ by HIV status, finds Canadian study

In women 40 or more years old, aging patterns that affect mortality may differ based on HIV status, indicated study findings presented at the 19th European AIDS Conference. Curiously, the study—conducted in British Columbia, Canada—found that cardiovascular risk did not follow the same pattern.

Participant Characteristics

Women ≥ 40 years old who participate in a community-based prospective cohort study, BC CARMA-CHIWOS Collaboration (bcc3), and did not have cardiovascular disease at baseline, were included in this study. Eighty-eight women living with HIV (WLWH) were compared to 124 HIV-negative controls (HNC).

Both groups were demographically similar, including a relatively high proportion of indigenous participants (30% in each group). A high proportion of participants reported experiencing homelessness at some point (48% WLWH, 46% HNC), current tobacco smoking (40% WLWH, 35% HNC), and current substance use (22% WLWH, 21% HNC). These proportions are significantly higher than in the general Canadian population, where 2% of people are unsheltered, 14% experience hidden homelessness, 10% smoke tobacco, and 3% use street drugs, said study presenter Tetiana Povshedna, a Ph.D. student at the University of British Columbia in Vancouver, Canada.

The one significant baseline difference between the study groups was hepatitis C virus (HCV) prevalence, with 42% of WLWH being HCV seropositive, compared to 15% of controls.

HIV was well-controlled among most WLWH: 86% had an undetectable viral load and the median CD4 count was 623 cells/mm³. For HIV-negative participants, a CD4 count of 700 cells/mm³ was assumed for calculation purposes.

Study Methods and Results

“Our research is community-based, which means that we have community research associates—women living with HIV trained in research,” Povshedna stated. “They are an integral part of the team, from the conception stage to administering of surveys—all the way to knowledge translation.”

The study estimated cardiovascular (CV) and all-cause mortality risk among women by HIV status using the Atherosclerotic Cardiovascular Disease (ASCVD) Risk Calculator for CV and the Veterans Aging Cohort Study (VACS) 2.0 index for mortality risk. A 5-year event horizon was used for mortality and a 10-year horizon for CV events.

Median ASCVD was 2.4 among WLWH and 3.4 among controls—both of which were considered low risk. An intermediate-high risk index of > 7.5 was calculated for 16% of WLWH and 20% of controls, a difference that fell well short of statistical significance. However, the median VACS was 6.8 among WLWH and 5.0 among controls—a finding that was statistically significant.

Thus, despite a lower CV risk and mostly well-controlled HIV, WLWH were still at higher risk of death than HIV-negative women with similar lived experience. “We can see that while both [CV and mortality] risks increase with age, women who have elevated cardiovascular risk … are not the same women who have the highest estimated all-cause mortality, potentially indicating that the two might not be related in this particular population,” explained Povshedna.

Results suggest that aging patterns in WLWH with mostly undetectable viral loads may differ from those in their HIV-negative counterparts, Povshedna said.

Next Steps

When plotting HCV status—which differed between groups—on a scatter graph, Povshedna noted that risk patterns did emerge, and said further study is needed in this area. In addition to looking at latent viral infections, further study of systemic inflammation, substance use, and chronic pain may also be needed, she said.

“Moving forward in our cohort, we plan to link cardiovascular and mortality risk estimates to other clinical and socio-structural determinants of health we are looking at to better understand predictors and correlates of healthy aging in women,” Povshedna said.

Study Information

Abstract PS4.O2, “Estimated risk of all-cause mortality and cardiovascular events in a cohort of women living with HIV and socio-demographically similar HIV-negative controls ≥40 years old,” was presented by Tetiana Povshedna on Oct. 19, 2023, at the 19th European AIDS Conference in Warsaw, Poland.

By Barbara Jungwirth