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. 2018 Apr 3;66(8):1230-1238.
doi: 10.1093/cid/cix998.

Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States

Cherise Wong  1 , Stephen J Gange  1 , Richard D Moore  2 , Amy C Justice  3 , Kate Buchacz  4 , Alison G Abraham  1 , Peter F Rebeiro  5 , John R Koethe  5 , Jeffrey N Martin  6 , Michael A Horberg  7 , Cynthia M Boyd  2 , Mari M Kitahata  8 , Heidi M Crane  8 , Kelly A Gebo  2 , M John Gill  9 , Michael J Silverberg  10 , Frank J Palella  11 , Pragna Patel  4 , Hasina Samji  12 , Jennifer Thorne  2 , Charles S Rabkin  13 , Angel Mayor  14 , Keri N Althoff  1 ; North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)
Collaborators, Affiliations

Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States

Cherise Wong et al. Clin Infect Dis. .

Abstract

Background: Age-associated conditions are increasingly common among persons living with human immunodeficiency virus (HIV) (PLWH). A longitudinal investigation of their accrual is needed given their implications on clinical care complexity. We examined trends in the co-occurrence of age-associated conditions among PLWH receiving clinical care, and differences in their prevalence by demographic subgroup.

Methods: This cohort study was nested within the North American AIDS Cohort Collaboration on Research and Design. Participants from HIV outpatient clinics were antiretroviral therapy-exposed PLWH receiving clinical care (ie, ≥1 CD4 count) in the United States during 2000-2009. Multimorbidity was irreversible, defined as having ≥2: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures.

Results: Among 22969 adults, 79% were male, 36% were black, and the median baseline age was 40 years (interquartile range, 34-46 years). Between 2000 and 2009, multimorbidity prevalence increased from 8.2% to 22.4% (Ptrend < .001). Adjusting for age, this trend was still significant (P < .001). There was no difference by sex, but blacks were less likely than whites to have multimorbidity (aPR, 0.87; 95% CI, .77-.99). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR, 1.16; 95% CI, 1.01-1.34). Hypertension and hypercholesterolemia most commonly co-occurred.

Conclusions: Multimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.

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Figures

Figure 1.
Figure 1.
Crude annual prevalence of age-associated conditions among antiretroviral therapy–experienced persons living with human immunodeficiency virus and receiving clinical care (N = 22969). Numbers within bars denote percentages. Abbreviation: HIV, human immunodeficiency virus.
Figure 2.
Figure 2.
Distribution of age-associated conditions by age among antiretroviral therapy–experienced persons living with human immunodeficiency virus and receiving clinical care in 2000 and 2009. Numbers within bars denote percentages. Abbreviation: HIV, human immunodeficiency virus.
Figure 3.
Figure 3.
The three most common age-associated conditions among antiretroviral therapy–experienced persons living with human immunodeficiency virus and receiving clinical care in 2000 and 2009. Abbreviations: CKD, chronic kidney disease; DM, diabetes mellitus.
See this image and copyright information in PMC

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