@article{9550d94dd84847fa9f33b5f28846f26f,
title = "Multimorbidity among Persons Living with Human Immunodeficiency Virus in the United States",
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.",
keywords = "HIV, age-associated conditions, aging, multimorbidity",
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",
note = "Funding Information: Financial support. This work was supported by the NIH (grants U01AI069918, F31DA037788, G12MD007583, K01AI093197, K23EY013707, K24AI065298, K24AI118591, K24DA000432, KL2TR000421, M01RR000052, N01CP01004, N02CP055504, N02CP91027, P30AI027757, P30AI027763, P30AI027767, P30AI036219, P30AI050410, P30AI094189, P30AI110527, P30MH62246, T32AG24718, R01AA016893, R24AG044325, R01CA165937, R01DA011602, R01DA012568, R24AI067039, U01AA013566, U01AA020790, U01AI031834, U01AI034989, U01AI034993, U01AI034994, U01AI035004, U01AI035039, U01AI035040, U01AI035041, U01AI035042, U01AI037613, U01AI037984, U01AI038855, U01AI038858, U01AI042590, U01AI068634, U01AI068636, U01AI069432, U01AI069434, U01AI103390, U01AI103397, U01AI103401, U01AI103408, U01DA03629, U01DA036935, U01HD032632, U10EY008057, U10EY008052, U10EY008067, U24AA020794,U54MD007587, UL1RR024131, UL1TR000004, UL1TR000083, UL1TR000454, UM1AI035043, Z01CP010214, and Z01CP010176); the CDC (contracts CDC-200-2006-18797 and CDC-200-2015-63931); the Agency for Healthcare Research and Quality (contract 90047713); the Health Resources and Services Administration (contract 90051652); the Canadian Institutes of Health Research (grants CBR-86906, CBR-94036, HCP-97105, and TGF-96118); the Ontario Ministry of Health and Long Term Care; and the Government of Alberta, Canada. Additional support was provided by the National Cancer Institute, the National Institute for Mental Health, and the National Institute on Drug Abuse. Funding Information: Potential conflicts of interest. C. W., S. J. G., R. D. M., A. C. J., A. G. A., J. R. K., J. N. M., M. A. H. C. M. B., H. M. C., M. J. G., and K. N. A. have grants received or pending from the NIH. R. D. M. has provided education presentations for Medscape. A. G. A. has lectured for the Johns Hopkins Graduate Summer Institute, served as a consultant for Mount Sinai, is a board member of the Observational Study Monitoring Board for the National Institute of Diabetes and Digestive and Kidney Diseases, and is employed by Johns Hopkins University. P. F. R. has grants received/pending from the NIH/National Institute of Allergy and Infectious Diseases. M. A. H. is employed by Mid-Atlantic Permanente Medical Group. K. A. G. has provided expert testimony for the federal government in an HIV case and has received grants from the Agency for Healthcare Research and Quality and the Health Resources and Services Administration. M. J. G. has served on boards for Merck, Gilead, and ViiV Healthcare. M. J. S. has received research grants from Merck and Pfizer. F. J. P. has lectured for Gilead Sciences, Janssen Pharmaceuticals, Merck, and Bristol-Meyers Squibb. J. T. has served as a consultant for Gilead Sciences. K. N. A. has served on the scientific advisory board for TrioHealth. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.",
year = "2018",
month = apr,
day = "3",
doi = "10.1093/cid/cix998",
language = "English (US)",
volume = "66",
pages = "1230--1238",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "8",
}