With the increased life expectancy of ART-treated individuals living with HIV, chronic non-communicable diseases (NCD) are becoming increasingly common. Trends in NCD among HIV-infected adults in North America, particularly among the most heavily affected subgroups, have not been studied. These data are needed in order for providers, health care systems, and policy-makers to prepare for the long-term management of those with HIV.
Our study population included ART-exposed, HIV-infected adults (≥18) in U.S. clinical care during 2000-2010 from the North American AIDS Cohort Collaboration on Research and Design. For this study, we had an interest in the prevalence of concurrent NCDs (multimorbidity), defined as having two or more of the following: hypertension, diabetes, chronic kidney disease, hypercholesterolemia, end-stage liver disease, and non-AIDS-related cancer. NCDs were time-updated and absorbent. Annual prevalence of multimorbidity was estimated among individuals who were in care (based upon having ≥1 CD4 measurement in the calendar year). Adjusted (aPR) prevalence ratios and 95% confidence intervals ([,]) for multimorbidity were estimated by Poisson regression with robust variance, using generalized estimating equations for repeated measures.
Our analysis included n=22,969 adults; 79% male, 36% black, and median age at entry was 40 years (IQR: 34 – 46). The frequency of multimorbidity was 12% (for 2 conditions), 4% (for 3), and 0.9% (for >3). Between 2000-2010, multimorbidity prevalence increased from 8.2% to 22.4% (p-trend<0.001; Figure 1). Hypertension and hypercholesterolemia were the most common co-occurring conditions. Adjusting for age, sex, race, HIV risk, year, regimen, years of ART, AIDS, CD4 at ART start, viral suppression, and CD4, individuals residing in the South (aPR=1.55 [1.30,1.85]) and the West (aPR=1.33 [1.11,1.60]) relative to the Northeast were more likely to have multimorbidity. There was no difference by sex and blacks were less likely to have multimorbidity (compared to whites, aPR=0.86 [0.75,0.98]).
The prevalence of multimorbidity has increased among those living with HIV. As the HIV-infected population ages with effective HIV treatment, the prevention and treatment of NCDs will increasingly become a critical co-management need for this population that care providers, health care systems and policy-makers must adapt to.