Lauren Collins, MD, MS

Association of Pregnancy History and Age with the Burden of Non-AIDS Comorbidities Among Women with and without HIV in the Southern U.S.

Lauren F. Collins1,2, C. Christina Mehta1, Ava Cox1, Qian Yang1, Tina Tisdale1, Martina L. Badell1, Ighovwerha Ofotokun1,2, Daniel Westreich3, Adaora Adimora3, Seble Kassaye4, Elizabeth F. Topper5, Deborah Konkle-Parker6, Aadia Rana7, Maria L. Alcaide8, Anandi N. Sheth1,2

1Emory School of Medicine, Atlanta, GA, USA
2Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
3University of North Carolina-Chapel Hill, NC, USA
4Georgetown University School of Medicine, Washington, D.C., USA
5Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
6Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
7University of Alabama-Birmingham Heersink School of Medicine, Birmingham, AL, USA
8University of Miami Miller School of Medicine, Miami, FL, USA

 

Women with HIV (WWH) have a higher burden and earlier onset of non-AIDS comorbidities (NACM) than women without HIV (WwoH); the impact of reproductive history is largely unknown.

We performed a cross-sectional analysis of the Study of Treatment And Reproductive outcomes (STAR) cohort, a longitudinal study of women 18-45 years old with and without HIV enrolled across 6 sites in the U.S. South. NACM prevalence and burden (total NACM count of 12 assessed) was determined at STAR enrollment. Pregnancy history was categorized as zero, 1-2, or ≥3 prior pregnancies. Linear regression models evaluated association of NACM burden with HIV serostatus, age, and pregnancy history.

Among 519 women (354 WWH; 165 WwoH), median age was 36 years, 75% reported non-Hispanic Black race, 45% ever smoked; 22%, 32%, and 46% had zero, 1-2, and ≥3 pregnancies, respectively. Among WWH, median CD4 count was 666 cells/mm3 and 77% had HIV-1 RNA <200 cp/ml. NACM prevalence was (WWH/WwoH): obesity (59%/55%), psychiatric illness (54%/46%), anemia (38%/30%), lung disease (30%/29%), hypertension (25%/26%), bone disease (25%/28%), diabetes (8%/6%), cardiovascular disease (7%/4%), liver disease (7%/1%), dyslipidemia (4%/3%), kidney disease (3%/1%), non-AIDS cancer (1%/1%). Among women with available data for all NACM assessed (n=332), WWH versus WwoH had a mean NACM burden of 2.5 vs 2.4, p=0.24. Among women overall, mean NACM burden increased with age group: 1.9 (18-24y), 2.2 (25-29y), 2.5 (30-34y), 2.7 (35-39y), 2.7 (40-45y) (p-trend=0.002). Among women with zero, 1-2, ≥3 pregnancies, age-adjusted mean NACM burden was 2.4, 2.2, and 2.6 (p-trend=0.20). HIV serostatus did not modify the effect of age and pregnancy history on NACM burden (HIV*age*pregnancy interaction p=0.76). Among women across HIV status, pregnancy history was associated with estimated NACM burden only in certain age groups: 18-24y (p-trend>0.99), 25-29y (p-trend=0.03), 30-34y (p-trend=0.11), 35-39y (p-trend=0.21), 40-45y (p-trend=0.71).

Among reproductive age women with and without HIV in the U.S. South, the burden of 12 NACM was high overall, increased with age, and was associated with pregnancy history in some age groups. These data may inform the development and timing of NACM screening and prevention strategies to be deployed across the reproductive lifecourse.