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Risk factors and impact of patterns of co-occurring comorbidities in people living with HIV

De Francesco, Davidea; Underwood, Jonathanb; Bagkeris, Emmanouila; Anderson, Janec; Williams, Iand; Vera, Jaime H.e; Post, Frank A.f; Boffito, Martag; Johnson, Margareth; Mallon, Patrick W.G.i; Winston, Alanb; Sabin, Caroline A.a on behalf of the Pharmacokinetic and Clinical Observations in PeoPle Over fiftY (POPPY) study

doi: 10.1097/QAD.0000000000002293

Aims: To assess associations of comorbidity patterns observed in people living with HIV (PLWH) with risk factors and health outcomes.

Methods: Common patters of comorbidities in PLWH participating in the Pharmacokinetic and Clinical Observations in People Over Fifty study were determined using principal component analysis and a severity score for each pattern was derived. Associations between each pattern's severity score and risk factors were assessed using median regression. The independent associations of patterns’ severity scores with self-reported physical and mental health (SF-36 summary scores) were assessed using linear regression, with functional impairment (Lawton IADL < 8) and hospitalization in last year using logistic regression and with number of general practitioner visits using Poisson regression.

Results: A total of 1073 PLWH were analysed: 85.2% male, median (interquartile range) age 52 (47–59) years, 98% on therapy. Duration of HIV was associated with higher severity in 4/6 of patterns: cardiovascular diseases, mental health problems, metabolic disorders and chest/other infections (all P ≤ 0.001). Prior AIDS was associated with higher severity scores for the same patterns and for the pattern of cancers (P < 0.001). The pattern of cardiovascular diseases was associated with poorer physical health (P = 0.02), higher risk of functional impairment (P = 0.02) and hospitalization (P < 0.001) and with higher number of general practitioner visits (P < 0.001). Severity of mental health (all P < 0.001) and of chest/other infections patterns negatively affected all the five health outcomes.

Conclusion: Common patterns of comorbidities seen in PLWH appear to have different risk factors and to differently affect health outcomes. These findings may assist the development of targeted intervention to prevent, treat and manage the increasingly prevalent multimorbidity in PLWH.

aInstitute for Global Health, University College London

bDivision of Infectious Diseases, Imperial College London

cHomerton University Hospital NHS Foundation Trust

dMortimer Market Centre, University College London, London

eBrighton and Sussex Medical School, Brighton

fKing's College Hospital NHS Foundation Trust

gChelsea and Westminster Healthcare NHS Foundation Trust

hRoyal Free NHS Trust, London, UK

iSchool of Medicine, University College Dublin, Dublin, Ireland.

Correspondence to Davide De Francesco, Institute for Global Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Tel: +44 20 7794 0500x38827; e-mail:

Received 3 April, 2019

Revised 2 May, 2019

Accepted 15 May, 2019

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Copyright © 2019 Wolters Kluwer Health, Inc.