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

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)

Research output: Contribution to journalArticle

20 Citations (Scopus)

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% (P trend <.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.

Original languageEnglish (US)
Pages (from-to)1230-1238
Number of pages9
JournalClinical Infectious Diseases
Volume66
Issue number8
DOIs
StatePublished - Apr 3 2018

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Comorbidity
HIV
Confidence Intervals
Hypercholesterolemia
Demography
Hypertension
End Stage Liver Disease
Heterosexuality
CD4 Lymphocyte Count
Ambulatory Care Facilities
Chronic Renal Insufficiency
Sex Characteristics
Diabetes Mellitus
Acquired Immunodeficiency Syndrome
Cohort Studies
Research Design
Delivery of Health Care
Neoplasms
Therapeutics

Keywords

  • age-associated conditions
  • aging
  • HIV
  • multimorbidity

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) (2018). Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States. Clinical Infectious Diseases, 66(8), 1230-1238. https://doi.org/10.1093/cid/cix998

Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States. / North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

In: Clinical Infectious Diseases, Vol. 66, No. 8, 03.04.2018, p. 1230-1238.

Research output: Contribution to journalArticle

North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) 2018, 'Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States', Clinical Infectious Diseases, vol. 66, no. 8, pp. 1230-1238. https://doi.org/10.1093/cid/cix998
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States. Clinical Infectious Diseases. 2018 Apr 3;66(8):1230-1238. https://doi.org/10.1093/cid/cix998
North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). / Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States. In: Clinical Infectious Diseases. 2018 ; Vol. 66, No. 8. pp. 1230-1238.
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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{\%} (P trend <.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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author = "{North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)} and Cherise Wong and Gange, {Stephen J.} and Moore, {Richard D.} and Justice, {Amy C.} and Kate Buchacz and Abraham, {Alison G.} and Rebeiro, {Peter F.} and Koethe, {John R.} and Martin, {Jeffrey N.} and Horberg, {Michael A.} and Boyd, {Cynthia M.} and Kitahata, {Mari M.} and Crane, {Heidi M.} and Gebo, {Kelly A.} and Gill, {M. John} and Silverberg, {Michael J.} and Palella, {Frank J.} and Pragna Patel and Hasina Samji and Jennifer Thorne and Rabkin, {Charles S.} and Angel Mayor and Althoff, {Keri N.} and Freeman, {Aimee M.} and Angela Cescon and Rachlis, {Anita R.} and Ben Rogers and Benigno Rodriguez and Chris Grasso and Benson, {Constance A.} and Drozd, {Daniel R.} and David Fiellin and David Haas and Kirk, {Gregory D.} and James Willig and Jason Globerman and Brooks, {John T.} and Eron, {Joseph J.} and Montaner, {Julio S.G.} and Karyn Gabler and Kathryn Anastos and Mayer, {Kenneth H.} and Jacobson, {Lisa P.} and Madison Kopansky-Giles and Klein, {Marina B.} and Megan Turner and Mugavero, {Michael J.} and Saag, {Michael S.} and Harrigan, {P. Richard} and Robert Dubrow",
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T1 - Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States

AU - North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)

AU - Wong, Cherise

AU - Gange, Stephen J.

AU - Moore, Richard D.

AU - Justice, Amy C.

AU - Buchacz, Kate

AU - Abraham, Alison G.

AU - Rebeiro, Peter F.

AU - Koethe, John R.

AU - Martin, Jeffrey N.

AU - Horberg, Michael A.

AU - Boyd, Cynthia M.

AU - Kitahata, Mari M.

AU - Crane, Heidi M.

AU - Gebo, Kelly A.

AU - Gill, M. John

AU - Silverberg, Michael J.

AU - Palella, Frank J.

AU - Patel, Pragna

AU - Samji, Hasina

AU - Thorne, Jennifer

AU - Rabkin, Charles S.

AU - Mayor, Angel

AU - Althoff, Keri N.

AU - Freeman, Aimee M.

AU - Cescon, Angela

AU - Rachlis, Anita R.

AU - Rogers, Ben

AU - Rodriguez, Benigno

AU - Grasso, Chris

AU - Benson, Constance A.

AU - Drozd, Daniel R.

AU - Fiellin, David

AU - Haas, David

AU - Kirk, Gregory D.

AU - Willig, James

AU - Globerman, Jason

AU - Brooks, John T.

AU - Eron, Joseph J.

AU - Montaner, Julio S.G.

AU - Gabler, Karyn

AU - Anastos, Kathryn

AU - Mayer, Kenneth H.

AU - Jacobson, Lisa P.

AU - Kopansky-Giles, Madison

AU - Klein, Marina B.

AU - Turner, Megan

AU - Mugavero, Michael J.

AU - Saag, Michael S.

AU - Harrigan, P. Richard

AU - Dubrow, Robert

PY - 2018/4/3

Y1 - 2018/4/3

N2 - 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% (P trend <.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.

AB - 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% (P trend <.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.

KW - age-associated conditions

KW - aging

KW - HIV

KW - multimorbidity

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