Multimorbidity prevalence increases among older people living with HIV
Multimorbidity prevalence increased from 2006 to 2016 among older adults living with HIV who visited one Ryan White HIV/AIDS Program clinic, according to a study published in Open Forum Infectious Diseases.
“While morbidity and mortality related to AIDS-related conditions have decreased, age-associated chronic conditions, such as cardiovascular disease, renal impairment, diabetes, non-AIDS defining malignancies, and osteoporosis are becoming increasingly common in people living with HIV (PLWH),” Elizabeth C. Arant, MD, fellow physician in the division of infectious diseases at the University of North Carolina at Chapel Hill, told Healio.
“There is evidence that multimorbidity, or the accumulation of multiple serious chronic health conditions, may be higher in PLWH. We were interested in comparing the prevalence of multimorbidity between two different cohorts of older PLWH in one southeastern Ryan White HIV/AIDS Program clinic (RWHAP) — one cohort from 2006 and another from 2016.”
According to the study, the cohorts included PLWH aged 45 to 89 years with more than one medical visit at one RWHAP Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2). The researchers assessed the data for associations between characteristics and multimorbidity defined as more than two chronic diseases, which included hypertension, obesity, type 2 diabetes, hypercholesterolemia, cardiovascular disease, chronic kidney disease, osteopenia and osteoporosis, chronic obstructive pulmonary disease, end-stage liver disease and non-AIDS related malignancy and HIV outcomes.
The study revealed that multimorbidity increased from Cohort 1 (n = 149; 12.8%) to Cohort 2 (n = 323; 29.7%). The researchers found that private insurance was associated with lower multimorbidity than Medicare (Cohort 1: aOR=0.15; 95% CI, 0.02-0.63; Cohort 2: aOR=0.53; 95% CI, 0.27-1). Among individuals in Cohort 2, the researchers found that multimorbidity was associated with female gender (aOR=2.57; 95% CI, 1.22-5.58) and that participants who lived in rural areas were more likely to be engaged in care compared with those who lived in urban areas (aOR=1.23; 95% CI, 1.10-1.38). Among those in Cohort 1, Black participants were less likely to be engaged in care compared with non-Black participants (aOR=0.72; 95% CI, 0.61-0.87). Additionally, the researchers found that multimorbidity was not associated with differences in HIV outcomes.
“Given the lower rate of multimorbidity for those with private insurance, RHWAP should consider a targeted investment to deliver more preventive care in RWHAP clinics with the goal of reducing multimorbidity prevalence in PLWH. The higher rate of multimorbidity in women in the aging PLWH population should be investigated further,” Arant said. “Older women living with HIV may need more targeted approaches at chronic disease prevention and management. While there is a federal plan to end the HIV epidemic, the U.S. and RHWAP must also continue to prevent, diagnose and treat PLWH’s comorbidities to ensure that PLWH continue to thrive.”