Noncommunicable Diseases Burden and Risk Factors in a Cohort of HIV+ Elderly Patients in Malawi

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.