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Open Forum Infect Dis. 2015 Jul 8;2(3):ofv108. doi: 10.1093/ofid/ofv108. eCollection 2015 Sep.

Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population.

Hasse B1, Tarr PE2, Marques-Vidal P3, Waeber G3, Preisig M4, Mooser V5, Valeri F6, Djalali S6, Andri R7, Bernasconi E8, Calmy A9, Cavassini M10, Vernazza P11, Battegay M12, Weber R1, Senn O6, Vollenweider P3, Ledergerber B1; CoLaus Cohort, FIRE and the Swiss HIV Cohort Study, Aubert V, Barth J, Battegay M, Bernasconi E, Böni J, Bucher HC, Burton-Jeangros C, Calmy A, Cavassini M, Egger M, Elzi L, Fehr J, Fellay J, Furrer H, Fux CA, Gorgievski M, Günthard H, Haerry D, Hasse B, Hirsch HH, Hösli I, Kahlert C, Kaiser L, Keiser O, Klimkait T, Kouyos R, Kovari H, Ledergerber B, Martinetti G, Martinez de Tejada B, Metzner K, Müller N, Nadal D, Pantaleo G, Rauch A, Regenass S, Rickenbach M, Rudin C, Schöni-Affolter F, Schmid P, Schultze D, Schüpbach J, Speck R, Staehelin C, Tarr P, Telenti A, Trkola A, Vernazza P, Weber R, Yerly S, Jean-Michel A, Murielle B, Jean Michel G, Christoph H, Thomas L, Pedro MV, Vincent M, Fred P, Martin P, Peter V, Roland VK, Aidacic V, Gerard W, Jürg B, Markus B, Heinz B, Martin B, Hans-Ulrich B, Ivo B, Reto C, Isabelle C, Corinne C, Sima D, Peter D, Simone E, Andrea F, Markus F, Claudius F, Jakob F, Ali GM, Matthias G, Denis H, Marcel H, Walter H, Simon H, Felix H, Paul H, Eva K, Vladimir K, Daniel K, Stephan K, Beat K, Benedict K, Heidi K, Vesna L, Giovanni L, Werner LH, Phillippe L, Severin L, Christoph M, Jürgen M, Damian M, Werner M, Titus M, Valentina N, Jakob R, Thomas R, Hana S, Frank S, Georg S, Oliver S, Pietro S, Jacques S, Alfred S, Alois S, Claudia S, Othmar S, Phuoc TT, Marco V, Alessandro V, René VA, Hans W, Fritz W, Johanna WS, Joseph W, Marco Z.

Author information

Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich.
Division of Infectious Diseases and Hospital Epidemiology , Kantonsspital Baselland Bruderholz, University of Basel , Bruderholz.
Departments of Medicine, Internal Medicine.
Pathology and Laboratory Medicine , Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois).
Institute of Primary Care, University of Zurich, University Hospital Zurich.
Division of Infectious Diseases and Hospital Epidemiology , University and Inselspital Berne.
Division of Infectious Diseases , Regional Hospital , Lugano.
Division of Infectious Diseases , University Hospital Geneva.
Division of Infectious Diseases , Centre Hospitalier Universitaire Vaudois and University of Lausanne.
Division of Infectious Diseases and Hospital Epidemiology , Cantonal Hospital , St. Gallen.
Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland.



 Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population.


 We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking.


 Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2-2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1-2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44-1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5-2.4; smoking: IRR = 2.0, 95% CI = 1.6-2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9-3.8; smoking: IRR = 2.6, 95% CI = 1.9-3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4-2.4; smoking: IRR = 1.7, 95% CI = 1.4-2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus.


 Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.


HIV-infection; comorbidity; multimorbidity

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