Trends in Age-Related Health Outcomes in People with HIV in Spain, 2006-2023.

Abstract

With antiretroviral therapy (ART), people living with HIV (PLHIV) live longer and face age-related health challenges. The long-term evolution of non-AIDS comorbidities in this population remains unclear. We assessed temporal trends in incidence and age at onset of major age-related outcomes in PLHIV. We conducted a longitudinal study using CoRIS, a nationwide cohort of ART-naive PLHIV in Spain. Participants were grouped into three calendar periods (2006-2011, 2012-2017, 2018-2023). The primary outcome was serious non-AIDS events (SNAEs), including major cardiovascular events, non-AIDS malignancies, and non-AIDS deaths. Secondary outcomes were hypertension, diabetes, dyslipidemia, heart failure, fracture, chronic kidney disease, dementia, and polypharmacy. Incidence was analyzed with Kaplan-Meier and Cox models, age at onset with adjusted linear regression. Analyses were stratified by sex. Among 18,659 participants (55,133 person-years), 85% were male, median age 35 years. SNAE incidence declined (adjusted HR for 2018-2023 vs 2006-2011: 0.68, 95%CI 0.50-0.92), with delayed predicted age at first event (42.2 to 48.6 years, p<0.001). Secondary comorbidity incidence was largely stable, while polypharmacy rose, especially in older adults and women. Women showed smaller reductions in SNAE incidence (from 9.3 to 6.5 per 1,000 person-years vs. 13.0 to 6.4 per 1,000 person-years in men) and higher rates of hypertension and diabetes. In Spain, serious age-related outcomes among PLHIV have declined with delayed onset, consistent with improvements in HIV management and prevention of comorbidities. However, persistent comorbidity burden and rising polypharmacy-particularly among women-highlight the need for targeted strategies.