Multimorbidity Among Persons Living with HIV in the U.S.

Abstract

Background

Age-associated conditions are increasingly common among persons living with HIV. 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 persons living with HIV 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 persons living with HIV and receiving clinical care (i.e., having ≥1 CD4 T-cell lymphocyte lab) in the U.S. during 2000–2009. Multimorbidity was irreversible, defined as having ≥2 of: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios and 95% confidence intervals comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures.

Results

Among 22,969 adults, 79% were male, 36% black, and median baseline age was 40 years (IQR: 34–46). Between 2000–2009, multimorbidity prevalence increased from 8.2% to 22.4% (p-trend<0.001). Adjusting for age, this trend was still significant (p<0.001). There was no difference by sex, however, blacks were less likely to have multimorbidity compared to whites (aPR=0.87 [0.77,0.99]). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR=1.16 [1.01,1.34]). Hypertension and hypercholesterolemia most commonly co-occurred.

Conclusions

Multimorbidity prevalence has increased among persons living with HIV. Comorbidity prevention and multi-subspecialty management of increasingly complex healthcare needs will be vital to ensuring they receive needed care.