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Clin Infect Dis. 2018 Apr 3;66(8):1230-1238. doi: 10.1093/cid/cix998.

Multimorbidity Among Persons Living with Human Immunodeficiency Virus in the United States.

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Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
Department of Medicine, Yale University, West Haven, Connecticut.
Centers for Disease Control and Prevention, Atlanta, Georgia.
Vanderbilt University School of Medicine, Nashville, Tennessee.
Department of Epidemiology, University of California, San Francisco.
Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland.
University of Washington, Seattle.
University of Calgary, Alberta, Canada.
Kaiser Permanente Division of Research, Kaiser Permanente Northern California, Oakland.
Northwestern University, Chicago, Illinois.
BC Centre for Disease Control and Simon Fraser University, Vancouver, British Columbia, Canada.
National Cancer Institute, Rockville, Maryland.
Universidad Central del Caribe, Bayamon, Puerto Rico.



Age-associated conditions are increasingly common among persons living with human immunodeficiency virus (HIV) (PLWH). A longitudinal investigation of their accrual is needed given their implications on clinical care complexity. We examined trends in the co-occurrence of age-associated conditions among PLWH receiving clinical care, and differences in their prevalence by demographic subgroup.


This cohort study was nested within the North American AIDS Cohort Collaboration on Research and Design. Participants from HIV outpatient clinics were antiretroviral therapy-exposed PLWH receiving clinical care (ie, ≥1 CD4 count) in the United States during 2000-2009. Multimorbidity was irreversible, defined as having ≥2: hypertension, diabetes mellitus, chronic kidney disease, hypercholesterolemia, end-stage liver disease, or non-AIDS-related cancer. Adjusted prevalence ratios (aPR) and 95% confidence intervals (CIs) comparing demographic subgroups were obtained by Poisson regression with robust error variance, using generalized estimating equations for repeated measures.


Among 22969 adults, 79% were male, 36% were black, and the median baseline age was 40 years (interquartile range, 34-46 years). Between 2000 and 2009, multimorbidity prevalence increased from 8.2% to 22.4% (Ptrend < .001). Adjusting for age, this trend was still significant (P < .001). There was no difference by sex, but blacks were less likely than whites to have multimorbidity (aPR, 0.87; 95% CI, .77-.99). Multimorbidity was the highest among heterosexuals, relative to men who have sex with men (aPR, 1.16; 95% CI, 1.01-1.34). Hypertension and hypercholesterolemia most commonly co-occurred.


Multimorbidity prevalence has increased among PLWH. Comorbidity prevention and multisubspecialty management of increasingly complex healthcare needs will be vital to ensuring that they receive needed care.

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