Human Immunodeficiency Virus (HIV) and Aging: Multimorbidity in Older People With HIV in One Nonurban Southeastern Ryan White HIV/AIDS Program Clinic

Abstract

Background Age-related chronic conditions are becoming more concerning for people with human immunodeficiency virus (PWH). We aimed to identify characteristics associated with multimorbidity and evaluate for association between multimorbidity and human immunodeficiency virus (HIV) outcomes. Methods Cohorts included PWH aged 45–89 with ≥1 medical visit at one Ryan White HIV/AIDS Program (RWHAP) Southeastern HIV clinic in 2006 (Cohort 1) or 2016 (Cohort 2). Multimorbidity was defined as ≥2 chronic diseases. We used multivariable logistic regression to assess for associations between characteristics and multimorbidity and between multimorbidity and HIV outcomes. Results Multimorbidity increased from Cohort 1 (n = 149) to Cohort 2 (n = 323) (18.8% vs 29.7%, P < .001). Private insurance was associated with less multimorbidity than Medicare (Cohort 1: adjusted odds ratio [aOR] = 0.15, 95% confidence interval [CI] = 0.02–0.63; Cohort 2: aOR = 0.53, 95% CI = 0.27–1.00). In Cohort 2, multimorbidity was associated with female gender (aOR, 2.57; 95% CI, 1.22–5.58). 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). In Cohort 2, participants with rural residences were more likely to be engaged in care compared with those with urban residences (aOR, 1.23; 95% CI, 1.10–1.38). Multimorbidity was not associated with differences in HIV outcomes. Conclusions Although PWH have access to RWHAP HIV care, PWH with private insurance had lower rates of multimorbidity, which may reflect better access to preventative non-HIV care. In 2016, multimorbidity was higher for women. The RWHAP and RWHAP Part D could invest in addressing these disparities related to insurance and gender.

Defining multimorbidity in people with HIV – what matters most?

“…Additionally, selection of conditions based on those observed in GP attendees may not necessarily reflect the conditions with the greatest burden (in terms of healthcare utilization or health outcomes) to an individual or healthcare system. Another US study [ 23 ] based their selection on what had been included in a Dutch study [ 16 ]. Although both studies considered a similar age group (aged ≥45 years), the reference study based their condition list on the availability of data (clinical/laboratory) rather than on the clinical significance of conditions among people with HIV.…”

“…However, the latter may have provided an outdated representation of relevant conditions among people with HIV at the time of the later study. Additionally, two US studies [ 23 , 31 ] referred to a publication from the AGEhIV Cohort Study in the Netherlands. However, there are likely to be country-level differences in terms of prevalent conditions among people with HIV which may have not been considered.…”

What is Polypharmacy In People Living With HIV/AIDS? A Systematic Review

“…There was a total of 36 de nitions of polypharmacy, with studies further divided based on the magnitude of polypharmacy (Table 1); minor polypharmacy (N = 3); major polypharmacy (N = 29); "severe" polypharmacy (N = 2); "excessive" polypharmacy (N = 1); "higher" polypharmacy (N = 1) (Table 2). Major 29 [2], [6], [8], [15], [17][18][19][20][21][22][23][24][25][26][27][28][29], [31][32][33][34][35][36][37][38][39][40] Severe 2 [23] [26] [39] Excessive 1 [11] Higher 1 [39] Duration of Polypharmacy Amongst the included studies, 16% (N = 5) incorporated the duration of treatment to the de nition of polypharmacy, while a signi cant proportion 84% (N = 26) only provided the numerical de nition of polypharmacy with no additional information on its duration. Gimeno-Gracia et al further strati ed drug exposure based on the following duration: greater than 1 day; greater than 90 days; and greater than 180 days [14,36].…”

The projected prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030

“…A study comparing multimorbidity prevalence in PWH ages 45-to-89-years-old attending one visit at a Ryan White HIV/AIDS Program clinic in 2016 vs 2006 observed an increase in multimorbidity prevalence among those of similar age and an increase in women (vs. men). 45 A study of physical multimorbidity in the NA-ACCORD noted the common comorbidity combinations included hypercholesterolemia, hypertension, and CKD in 2009. 24 Over the next decade, these metabolic and vascular diseases may drive the PEARL-projected increases in diabetes, CKD, and MIs.…”