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