Multimorbidity Patterns in HIV-Infected Patients

Abstract

Background Increases in multimorbidity and obesity have been noted in HIV infected populations in the current treatment era. Patterns of multimorbid disease clustering as well as the impact of obesity on multimorbidity are understudied in this population. Methods We examined obesity and multimorbidity patterns among 1844 HIV-infected patients in the UAB 1917 Clinic. Exploratory factor analysis (EFA) was used to identify the underlying factor structure responsible for clustering. Patterns among the resulting morbidity factors by body mass index (BMI) category were explored. Multivariable logistic regression models were fit to identify predictors of multimorbidity cluster patterns. Results The prevalence of multimorbidity was 65% (1205/1844). Prevalence increased with progressive BMI categories from underweight (64%) to obese (79%). Three multimorbidity clusters were identified: “Metabolic” including hypertension (HTN), gout, diabetes mellitus, and chronic kidney disease (CKD) (range: 0.41 to 0.84; P<0.001); “Behavioral“ including mood disorders, dyslipidemia, chronic obstructive pulmonary disease (COPD), chronic ulcer disease, osteoarthritis, obstructive sleep apnea (OSA), and cardiac disorders (range: 0.32 to 0.57; P<0.001); “Substance Use” including alcohol abuse, substance abuse, tobacco abuse, and hepatitis C (range: 0.53 to 0.89; P<0.001). Obesity was associated with increased odds of multimorbidity (Obese vs. Normal BMI category: OR=1.52, 95%CI=1.15-2.00). Conclusions Three patterns of disease clustering were identified. Obesity was associated with a higher likelihood of multimorbidity. The management of multimorbidity and obesity will need to be addressed in future clinical practice guidelines to enhance long term outcomes of HIV-infected patients in the current treatment era.

Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol

“…Food insecurity in US urban centers extends beyond the homeless and marginally housed to individuals with stable housing (Franke et al, 2011; Vogenthaler et al, 2011). Ultimately, food insecurity in combination with being underweight or overweight contributes to the mortality of people living with HIV/AIDS (Kim et al, 2012; Weiser, Fernandes, et al, 2009). …”

The Fat of the Matter: Obesity and Visceral Adiposity in Treated HIV Infection

“…Some weight gain following ART initiation may be attributable to a “return to health” phenomenon; however, excessive weight gain can occur, with persons with the highest pre-ART HIV-1 RNA or lowest CD4 + T lymphocyte counts at risk for greater weight gain[10, 11]. Further exemplifying the fact that weight gain can represent differential effects depending on the host, weight gain among underweight persons has been associated with a decline in circulating high-sensitivity C-reactive protein levels[12] and improved survival[13], whereas weight gain among overweight or obese individuals has been associated with significant increases in circulating levels of the monocyte activation marker soluble CD14[12], no mortality benefit[13] and a ≥67% prevalence of multi-morbidity[14]. …”

Fat Matters: Understanding the Role of Adipose Tissue in Health in HIV Infection

“…Similarly, a recent Veterans Aging Cohort Study analysis observed improved survival with weight gain in the first year of ART among underweight or normal weight but not overweight or obese participants [14]. Furthermore, overweight or obese HIV-infected individuals have a ≥67% prevalence of multi-morbidity [15]. In contrast, weight loss or failure to gain weight following ART initiation may be a poor prognostic sign or marker of concomitant infection or severe wasting [16].…”