Quantifying the future clinical burden of an ageing HIV
Transcript
Quantifying the future clinical burden of an ageing HIV
Quantifyingthefutureclinicalburdenof anageingHIV-positivepopulationinItaly: amathematicalmodellingstudy MikaelaSmit1,RachelCassidy1,AlessandroCozzi-Lepri2,EnricoGirardi3,Alessia Mammone3,AndreaAntinori3,Gioacchino Angarano4,FrancescaBai5,StefanoRusconi6,Giacomo Magnani7,Antonellad’Arminio Monforte5,TimothyBHallet1. Affiliations:1ImperialCollege,London,UK.2.UniversityCollegeLondon,UK.3.INMILSpallanzani,Roma,Italy.4.AlsoMoroUniversityofBari,Bari,Italy.5.S.PaoloHospital UniversityofMilano,Milano,Italy.6.SaccoHospital,Milano,Italy.7.Arcispedale S.MariaNuova,ReggioEmilia,Italy.CorrespondencetoDrMikaelaSmit,DepartmentofInfectious DiseaseEpidemiology,FacultyofMedicineatStMary’sCampus,ImperialCollegeLondon,W21PG.UK.E-mail:[email protected]. BACKGROUND RESULTS– FUTUREAGESTRUCTURE RESULTS– DRIVERSOFNCD RESULTS § TheageingHIV-positivepopulationhasbeen § Themodelprojectsthatthemeanageamongst § TherisingNCDburdeninItalywillbedrivenby showntoexperienceanexcessburdenofnoncommunicablediseases(NCDs)comparedto uninfectedpersons1. § Country-specificforecastsofNCDburdenwillbe keytoguidefutureHIVpoliciesonoptimal managementofmulti-morbidpatientsand whichscreeningandtreatmentserviceswillbe mostneeded. § Recentmodel-basedprojectionsinThe Netherlandsshowedtheclinicalimplicationsof anageingpopulationcharacterisedbyasharp increaseintheburdenofNCDs,andpotential complicationswithuseofco-medication.2 patientsonARTwillincreasefrom46.1to58.8 inItalybetween2015and2035. § TheproportionofpatientsonARTaged≥50 yearsoldwillincreasefrom30%to76% between2015and2035. CVD(hypertension,dyslipidaemia,strokesor MIs),diabetes,andCKD. § CVDwillcontributethegreatestburden, affecting57%ofpatientsin2015and85%by 2035. A. 2015 B. 2025 C. 2035 AIM § Tousemodel-basedanalysestoprovide nationalforecastofthefutureagestructureand NCDburdenamongstHIV-positivepatientson antiretroviraltherapy(ART)inItaly. METHOD- DATA § Themodelwasdesignedusinginformationfrom 7,469HIV-positivepatientsonARTreceiving carefrom1997onwardsatanyofthe42 infectiousdiseasecentresregisteredwiththe ICONA(ItalianCohortNaïvetoAntiretrovirals) FoundationStudy. § NationalsurveillancedataonHIVincidence,and numberofpeoplestatingARTwasusedto extrapolatethemodeltonationallevel3. Figure1.TheagedistributionofHIV-positive patientsonantiretroviraltherapyinItaly between2015and2035. RESULTS– FUTUREBURDENOF NCDS § TheproportionofpatientsonARTwithnoNCDs willdecreasefrom36%to11%between2015 and2035inItaly. § TheproportionofpatientsonARTwiththreeor moreNCDswillincreasefrom10%to46% between2015and2035. Figure3.Diagramrepresentingthechangesin relativenumberofpatientswithspecificNCDs andoverlapinNCDsinA.2015,B.2025,andC. 2035.Thearearepresentstherelativenumber ofHIV-patientswithNCDs.Abbreviations: Cardiovasculardisease(CVD),ChronicKidney Disease(CKD). METHOD- MODEL CONCLUSIONS § Weadaptedanindividual-modeloftheageing § HIV-positivepatientsinItalyareageingandwill HIV-positivepopulationtoItaly.2 § ModelfollowsageingItalianHIV-positive populationonARTfrom1stJanuary2010to 31stDecember2035ordeathand probabilisticallysimulatesclinicalevents (hypertension,dyslipidaemia,chronickidney disease(CKD),diabetes,non-AIDSdefining malignancies,strokesormyocardialinfractions (MIs),andmortality). § Themodelwasbuiltusing1997-2010data,and validatedagainst2010-2015out-of-sampledata toensureprojectionrobustnesspriorto expandingtonationallevel. § Modelresultswerebasedontheaverageof100 modelsimulations. Figure2.Stackedbargraphofprojectedburden ofNCDsinHIV-positivepatientson antiretroviraltherapybetween2015and2035 inItaly. References: 1. Althoff KN,SmitM,ReissP,JusticeAC.HIVandageing.Curr Opin HIVAIDS[Internet].2016Sep;11(5):527–36.Availablefrom:http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=01222929-201609000-00012 2. SmitM,BrinkmanK,Geerlings S,SmitC,Thyagarajan K,Sighem Avan,etal.FuturechallengesforclinicalcareofanageingpopulationinfectedwithHIV:amodellingstudy.LancetInfect Dis[Internet].2015Jul;15(7):810–8. 3. UNAIDS.NumberofpeoplelivingwithHIV[Internet].2015[cited2016Jul17].Availablefrom:http://aidsinfo.unaids.org/ BOARDOFDIRECTORSAd’ArminioMonforte(Vice-President),MAndreoni,GAngarano,AAntinori,F Castelli,R Cauda,GDiPerri,MGalli,R Iardino,GIppolito,ALazzarin,CFPerno,F vonSchloesser,P Viale.SCIENTIFICSECRETARYAd’ArminioMonforte,AAntinori,ACastagna,F Ceccherini-Silberstein,ACozzi-Lepri,EGirardi,S LoCaputo,CMussini,MPuoti.STEERINGCOMMITTEEM Andreoni,AAmmassari,AAntinori,CBalotta,ABandera,P Bonfanti,S Bonora,MBorderi,ACalcagno,LCalza,MRCapobianchi,ACastagna,F Ceccherini-Silberstein,ACingolani,P Cinque,ACozzi-Lepri,Ad’ArminioMonforte,ADeLuca,ADiBiagio,EGirardi,N Gianotti,AGori,GGuaraldi,GLapadula,MLichtner,S LoCaputo,GMadeddu,F Maggiolo,GMarchetti,S Marcotullio,LMonno,C Mussini,S Nozza,MPuoti,EQuiros Roldan,R Rossotti,S Rusconi,MMSantoro,ASaracino,MZaccarelli. STATISTICALANDMONITORINGTEAMACozzi-Lepri,IFanti,LGalli,P Lorenzini,ARodano,MShanyinde,ATavelli.BIOLOGICALBANKINMIF Carletti,S Carrara,ADiCaro,S Graziano,F Petrone,GProta,S Quartu,S Truffa.PARTICIPATINGPHYSICIANSANDCENTERSAGiacometti,A Costantini,CValeriani(Ancona);GAngarano,LMonno,CSantoro(Bari);F Maggiolo,CSuardi(Bergamo);P Viale,VDonati,GVerucchi (Bologna);F Castelli,EQuiros Roldan,CMinardi(Brescia);TQuirino,CAbeli (BustoArsizio);PEManconi,P Piano(Cagliari);BCacopardo,BCelesia(Catania);J Vecchiet,KFalasca (Chieti);LSighinolfi,DSegala(Ferrara);F Mazzotta,F Vichi(Firenze);GCassola,C Viscoli,AAlessandrini,N Bobbio,GMazzarello(Genova);CMastroianni,VBelvisi (Latina);P Bonfanti,ICaramma (Lecco);AChiodera,P Milini (Macerata);MGalli,ALazzarin,GRizzardini,MPuoti,Ad’ArminioMonforte,ALRidolfo,R Piolini,ACastagna,S Salpietro,LCarenzi,MCMoioli,CTincati,GMarchetti(Milano);CMussini,CPuzzolante (Modena);AGori,GLapadula(Monza);N Abrescia,A Chirianni,GBorgia,R Orlando,F DiMartino,LMaddaloni,IGentile,GBonadies (Napoli);ACascio,CColomba(Palermo);F Baldelli,ESchiaroli (Perugia);GParruti,TUrsini(Pescara);GMagnani,MAUrsitti (ReggioEmilia);R Cauda,MAndreoni,AAntinori,VVullo,ACristaudo,ACingolani,GBaldin,S Cicalini,LGallo,ENicastri,R Acinapura,MCapozzi,R Libertone,S Savinelli,ALatini,GIaiani,L FontanelliSulekova (Roma);MCecchetto,F Viviani(Rovigo);MSMura,GMadeddu (Sassari);ADeLuca,BRossetti(Siena);DFrancisci,CDiGiuli(Terni);P Caramello,GDiPerri,GCOrofino,S Bonora,MSciandra (Torino);MBassetti,ALondero(Udine);GPellizzer,VManfrin(Vicenza). sufferfromanincreasingNCDburden. § CVD,CKDanddiabetesinparticularwill contributetoNCDburden. § TrendsweresimilartoforecastsmadeforThe Netherlands2 withtheexceptionthatCKDis expectedtocontributeagreaterburdenby 2035inItaly(30%)thanTheNetherlands(in 2030,14%). § Toensurethebestoveralllong-termhealth, optimalselectionofARTandco-medication choiceismaintainedforthesepopulations, multi-disciplinarypatientmanagementand enhancedcommunicationbetweenHIV specialists,geriatricmedicineandprimarycare mustbedeveloped. Funding: ThisstudywassupportedbyGileadScience