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Open Forum Infect Dis. 2018 Oct 24;5(11):ofy272. doi: 10.1093/ofid/ofy272. eCollection 2018 Nov.

Patterns of Co-occurring Comorbidities in People Living With HIV.

Collaborators (165)

Babalis D, Boffito M, Burgess L, Mallon P, Post F, Sabin CA, Sachikonye M, Winston A, Anderson J, Asboe D, Boffito M, Garvey L, Mallon P, Post F, Pozniak A, Sabin CA, Sachikonye M, Vera J, Williams I, Winston A, Clarke A, Vera J, Bexley A, Richardson C, Kirk S, Gleig R, Boffito M, Asboe D, Pozniak A, Bracchi M, Pagani N, Cerrone M, Bradshaw D, Ferretti F, Higgs C, Seah E, Fletcher S, Anthonipillai M, Moyes A, Deats K, Syed I, Matthews C, Fernando P, Chiwome C, Hardwick S, Anderson J, Mguni S, Clark R, Nevin-Dolan R, Pelluri S, Post F, Campbell L, Yurdakul S, Okumu S, Pollard L, Santana-Suarez B, Mallon P, Macken A, Ghavani-Kia B, Maher J, Byrne M, Flaherty A, Babu S, Williams I, Otiko D, Phillips L, Laverick R, Beynon M, Salz AL, Severn A, Winston A, Garvey L, Underwood J, Tembo L, Stott M, McDonald L, Dransfield F, Whitehouse A, Burgess L, Babalis D, Johnson M, Ngwu N, Hemat N, Jones M, Carroll A, Kinloch S, Youle M, Madge S, Sabin CA, Francesco D, Bagkeris E, Reiss P, Wit FWNM, van der Valk M, Schouten J, Kooij KW, van Zoest RA, Verheij E, Verboeket SO, Elsenga BC, Prins M, van der Loeff MFS, Del Grande L, Olthof V, Dijkstra M, Zaheri S, Hillebregt MMJ, Ruijs YMC, Benschop DP, El Berkaoui A, Kootstra NA, Harskamp-Holwerda AM, Maurer I, Ruiz MMM, Girigorie AF, Boeser-Nunnink B, Zikkenheiner W, Janssen FR, Geerlings SE, Goorhuis A, Hovius JWR, Nellen FJB, van der Poll T, Prins JM, Reiss P, van der Valk M, Wiersinga WJ, van Vugt M, de Bree G, Wit FWNM, van Eden J, van Hes AMH, Pijnappel FJJ, Weijsenfeld A, Smalhout S, van Duinen M, Hazenberg A, Postema PG, Bisschop PHLT, Serlie MJM, Lips P, Dekker E, van der Velde N, Willemsen JMR, Vogt L, Schouten J, Portegies P, Schmand BA, Geurtsen GJ, Verbraak FD, Demirkaya N, Visser I, Schadé A, Nieuwkerk PT, Langebeek N, van Steenwijk RP, Dijkers E, Majoie CBLM, Caan MWA, van Lunsen HW, Nievaard MAF, van den Born BJH, Stroes ESG, Mulder WMC, van Oorspronk S.

Author information

1
Institute for Global Health, University College London, London, UK.
2
Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam and Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
3
Division of Infectious Diseases, Imperial College London, London, UK.
4
UCD School of Medicine, Dublin, Ireland.

Abstract

Background:

The aims of this study were to identify common patterns of comorbidities observed in people living with HIV (PLWH), using a data-driven approach, and evaluate associations between patterns identified.

Methods:

A wide range of comorbidities were assessed in PLWH participating in 2 independent cohorts (POPPY: UK/Ireland; AGEhIV: Netherlands). The presence/absence of each comorbidity was determined using a mix of self-reported medical history, concomitant medications, health care resource use, and laboratory parameters. Principal component analysis (PCA) based on Somers' D statistic was applied to identify patterns of comorbidities.

Results:

PCA identified 6 patterns among the 1073 POPPY PLWH (85.2% male; median age [interquartile range {IQR}], 52 [47-59] years): cardiovascular diseases (CVDs), sexually transmitted diseases (STDs), mental health problems, cancers, metabolic disorders, chest/other infections. The CVDs pattern was positively associated with cancer (r = .32), metabolic disorder (r = .38), mental health (r = .16), and chest/other infection (r = .17) patterns (all P < .001). The mental health pattern was correlated with all the other patterns (in particular cancers: r = .20; chest/other infections: r = .27; both P < .001). In the 598 AGEhIV PLWH (87.6% male; median age [IQR], 53 [48-59] years), 6 patterns were identified: CVDs, chest/liver, HIV/AIDS events, mental health/neurological problems, STDs, and general health. The general health pattern was correlated with all the other patterns (in particular CVDs: r = .14; chest/liver: r = .15; HIV/AIDS events: r = .31; all P < .001), except STDs (r = -.02; P = .64).

Conclusions:

Comorbidities in PLWH tend to occur in nonrandom patterns, reflecting known pathological mechanisms and shared risk factors, but also suggesting potential previously unknown mechanisms. Their identification may assist in adequately addressing the pathophysiology of increasingly prevalent multimorbidity in PLWH.

KEYWORDS:

HIV; comorbidities; multimorbidity; patterns of comorbidities

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