Cross-sectional study of correlates and prevalence of functional and high-risk multimorbidity in an academic HIV practice in New York City

Abstract

ObjectivesPeople with HIV have high levels of multimorbidity, but studies often focus on high-risk comorbidities such as hypertension or coronary artery disease. We examined both high-risk and functional comorbidities in an ethnically diverse clinic population to compare the prevalence of comorbidities and different patterns of multimorbidity.DesignRetrospective cross-sectional study.SettingUniversity-based primary care HIV clinic with two locations in New York City.ParticipantsPatients who had been seen by a physician at least once between 1 June 2016 and 31 May 2017.Primary and secondary outcome measuresData regarding demographics, diagnoses and lab values were downloaded in a one-time data import from the electronic medical record. Comorbidities were classified as high-risk (with major impact on mortality) or functional (with major impact on function), and multimorbidity was determined for both classes in the total sample of 2751. Factors associated with high-risk and functional multimorbidity were determined first through bivariate analysis and then through multivariable median regression in 2013 patients with complete data.ResultsMedian age was 52 years (IQR 43–59). Cisgendered women comprised 24.6% of the sample, and 31.7% were African-American. Both functional and high-risk comorbidities were common and risk increased with age. Among those 75 and older, median number of both functional and high-risk comorbidities was 3 (IQR 2–4). High-risk comorbidities were associated with age (p<0.001), more years with an HIV diagnosis (p<0.001) and being an African-American (p<0.001). Associated with a higher number of functional comorbidities were age (p<0.001), being a cisgender female (p<0.001), being Hispanic (p=0.01) and more years with an HIV diagnosis (p<0.001).ConclusionsComorbidities with functional impact increase with age in parallel to those with a more direct impact on mortality and should be assessed and monitored, especially as the population with HIV ages.

Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study

“…37 It has also been suggested that bidirectional influences between chronic conditions and age-related functional impairments can promote cellular senescence and mitochondrial dysfunction, increasing cardiovascular aging and impacting the health-related quality of life. 38 , 39 Ultimately, there is a need to better understand the ways in which chronic conditions, functional limitations, and mental health coexist to influence the risk of HF.…”

An overview of multimorbidity and polypharmacy in older people living with HIV

“…24 Yet another study classified comorbidities into high-risk comorbidity and functional comorbidity. 22 For older PLHIV, the latter defining classification of multimorbidity may correlate with the goals of care, as functional status impacts an individual's quality of life.…”

“…Some studies clustered comorbidities into categories of general medical conditions, and conditions seen in people who have HIV such as sexually transmitted diseases, substance use or their complications 24 . Yet another study classified comorbidities into high‐risk comorbidity and functional comorbidity 22 . For older PLHIV, the latter defining classification of multimorbidity may correlate with the goals of care, as functional status impacts an individual's quality of life.…”

“…Research indicates that in older PLHIV, the burden of multimorbidity and polypharmacy is more linked to the duration of HIV infection than to advanced age itself. 8 The non-communicable comorbidities in older PLHIV include metabolic disordershypertension and hyperlipidemia, 9,10 cardiovascular diseases, 11,12 anemia, 10 kidney disease, 13 and age-related conditions, 14 such as cognitive impairment, [15][16][17][18] frailty, [18][19][20] bone disease, 21 multimorbidity 8,10,[22][23][24][25][26] and polypharmacy, 7,10,[26][27][28][29] but are not limited to those listed. Furthermore, studies have shown that in older patients, mental health issues often coexist with physical medical conditions.…”