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 language | English (US) |
|---|---|
| Pages (from-to) | 1230-1238 |
| Number of pages | 9 |
| Journal | Clinical Infectious Diseases |
| Volume | 66 |
| Issue number | 8 |
| DOIs | |
| State | Published - Apr 3 2018 |
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Keywords
- age-associated conditions
- aging
- HIV
- multimorbidity
ASJC Scopus subject areas
- Microbiology (medical)
- Infectious Diseases
Cite this
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 journal › Article
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TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=85045132777&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85045132777&partnerID=8YFLogxK
U2 - 10.1093/cid/cix998
DO - 10.1093/cid/cix998
M3 - Article
C2 - 29149237
AN - SCOPUS:85045132777
VL - 66
SP - 1230
EP - 1238
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
SN - 1058-4838
IS - 8
ER -