As people with HIV (PWH) receiving antiretroviral therapy (ART) age, the projected burden and racial disparities of age-related comorbidities among key-populations remain uncertain.
ProjEcting Age, MultimoRbidity, and PoLypharmacy (PEARL) is an agent-based simulation of HIV and comorbidities among PWH receiving ART in the US (2009–2030). PEARL assesses nine major mental/physical comorbidities, including depression and anxiety, treated hypertension, diabetes, hyperlipidemia, chronic kidney disease (CKD), cancer, myocardial infarction (MI), and end-stage liver disease (ESLD). These are modeled in the presence/absence of three underlying risk-factors, including smoking, Hepatitis C virus (HCV) infection, and body mass index (BMI) change 2-year post-ART. Future comorbidity incidence is estimated at an individual-level from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). Our objective was to project multimorbidity (2+ physical comorbidities) burden among 15 key-populations in the US defined by race/ethnicity (White, Black, and Hispanic), sex (male, female), and acquisition risk group (men who have sex with men [MSM], injection drug use [IDU], and heterosexual contact) to year 2030.
Accompanying an increase in median age of PWH (50 to 53 years), the projected prevalence of multimorbidity increased from 2020 to 2030 overall (from 30.3% to 34.7%) and among all 15 key-populations (Figure). Racial disparities expand over time, with the highest and lowest multimorbidity burden projected among Black IDU women (74.7%) and Hispanic MSM (20.9%) in 2030. Hispanic heterosexual women experienced the largest multimorbidity burden increase (absolute difference=23.5%), while multimorbidity burden reduced slightly among White and Black heterosexual men (<-2% change). Anxiety (mean prevalence [range]= 0.54 [0.12–0.82]) and depression (0.49 [0.26–0.64]) were among the most prevalent comorbidities across all key-populations in 2030, followed by hypertension (0.38 [0.15–0.59]), CKD (0.36 [0.13–0.88]) and diabetes (0.31 [0.11–0.48]).
The prevalence of multimorbidity in PWH is projected to increase over the next decade. the most prevalent comorbidities, particularly anxiety, depression, hypertension, CKD, and diabetes, differ by race/ethnicity, sex, and transmission category. Focusing on the most burdensome comorbidities in each key-population can help with the long-term care and life-expectancy of PWH.
