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IMPACT AND DETERMINANTS OF COMORBIDITY CLUSTERS IN PEOPLE LIVING WITH HIV
Davide De Francesco1, Sebastiaan Verboeket2, Jonathan Underwood3, Ferdinand Wit2, Emmanouil Bagkeris1, Patrick W. Mallon4, Alan Winston3, Peter Reiss2, Caroline Sabin1
1University College London, London, UK,2Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands,3Imperial College London, London, UK,4University College Dublin, Dublin, Ireland
Comorbidities in people living with HIV (PLWH) may occur in clusters, potentially affecting quality of life and general health in different ways. We explored associations of risk factors and patient reported health outcomes with common clusters of co-occurring comorbidities.
We considered 65 comorbidities reported by PLWH via a structured interview with trained staff. Principal component analysis was used to identify non-random clusters of co-occurring comorbidities and obtain a score for each cluster proportional to the number of comorbidities included in the cluster and present in an individual. Cluster scores were standardised (mean=0, SD=1), with higher scores indicating a greater number of comorbidities characterising a cluster. Multivariable median regression was then used to investigate associations of sociodemographic, lifestyle and HIV-specific factors with each cluster score. Multivariable linear regression was used to evaluate associations of cluster scores (independently of each other) with physical and mental health summary scores (obtained from SF-36 questionnaire, range 0-100).
In 1073 PLWH (85% male, 84% white ethnicity, median (IQR) age 52 (47-59) years) we identified 6 comorbidity clusters (Table). 'CVDs', 'metabolic' and 'chest/other infections' scores were independently associated with older age and longer time since HIV diagnosis (all p's<0.001). Higher body-mass index was associated with higher scores in the 'CVDs' (p=0.009), 'cancers' (p=0.03) and 'metabolic' clusters (p=0.006). PLWH with prior AIDS events had higher scores than PLWH without prior AIDS events for all clusters (p<0.05) except 'STDs'. Associations with smoking and alcohol consumption were weak across all clusters (all p's>0.05). Higher scores in the 'mental health' and 'chest/other infections' clusters were independently associated with poorer SF-36 physical (p's<0.001) and mental health scores (p<0.001 and p=0.03, respectively - Table). 'CVDs' and 'cancers' scores were associated with poorer physical (p=0.02, p=0.03) but not mental health (p's>0.05).
Comorbidity clusters in PLWH are associated with different demographic, lifestyle and HIV-related factors, and significantly impact on quality of life, particularly physical functioning. Identifying common comorbidity clusters in PLWH may help prioritise interventions for those at risk for poorer health outcomes and focus research to understand common pathophysiological pathways contributing to comorbidities in treated PLWH.