First occurrence of diabetes, chronic kidney disease, and hypertension among North American HIV-infected adults, 2000-2013

There remains concern regarding the occurrence of non-communicable diseases (NCDs) among individuals aging with HIV but few studies have described whether disparities between demographic subgroups are present among individuals on antiretroviral therapy (ART) with access to care. We assessed the first documented occurrence of type 2 diabetes mellitus (DM), chronic kidney disease (CKD), and treated hypertension (HTN) by age, sex, and race within the North American AIDS Cohort Collaboration on Research and Design. HIV-infected adults (?18 years) who initiated ART were observed for first NCD occurrence between 1 January 2000 – 31 December 2013. Cumulative incidences as of age 70 were estimated accounting for the competing risk of death; Poisson regression was used to compare rates of NCD occurrence by demographic subgroup. We included >50,000 persons with >250,000 person-years (PY) of follow-up. Median follow-up was 4.7 years (interquartile range (IQR): 2.4-8.1). Rates of first occurrence (per 100 PY) were: 1.2 for DM, 0.6 for CKD, and 2.6 for HTN. Relative to non-black women, the cumulative incidences were increased in black women (68% vs. 51% for HTN, 52% vs. 41% for DM, and 38% vs. 35% for CKD; all p<0.001); this disparity was also found among men (73% vs. 60% for HTN, 44% vs. 34% for DM, and 30% vs. 25% for CKD; all p<0.001). Racial disparities in the occurrence of DM, CKD, and HTN emphasize the need for prevention and treatment options for these HIV populations receiving care in North America.

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