Mefford Matthew T, Silverberg Michael J, Leong Thomas K, Hechter Rulin C, Towner William J, Go Alan S, Horberg Michael, Hu Haihong, Harrison Teresa N, Sung Sue Hee, Reynolds Kristi
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
Division of Research, Kaiser Permanente Northern California, Oakland, CA.
Mayo Clin Proc Innov Qual Outcomes. 2022 May 3;6(3):218-227. doi: 10.1016/j.mayocpiqo.2022.03.004. eCollection 2022 Jun.
To examine the association between multimorbidity burden and incident heart failure (HF) among people with HIV (PWH) and people without HIV (PWoH).
The HIV-HEART study is a retrospective cohort study that included adult PWH and PWoH aged 21 years or older at Kaiser Permanente between 2000 and 2016. Multimorbidity burden was defined by the baseline prevalence of 22 chronic conditions and was categorized as 0-1, 2-3, and 4 or more comorbidities on the basis of distribution of the overall population. People with HIV and PWoH were followed for a first HF event, all-cause death, or up to the end of follow-up on December 31, 2016. Using Cox proportional hazard regression, hazard ratios and 95% CIs were calculated to examine the association between multimorbidity burden and incident HF among PWH and PWoH, separately.
The prevalences of 0-1, 2-3, and 4 or more comorbidities were 83.3%, 13.0%, and 3.7% in PWH (n=38,868), and 82.2%, 14.3%, and 3.5% in PWoH (n=386,586), respectively. After multivariable adjustment, compared with people with 0-1 comorbidities, the hazard ratios of incident HF associated with 2-3 and 4 or more comorbidities were 1.33 (95% CI, 1.04-1.71) and 2.41 (95% CI, 1.78-3.25) in PWH and 2.10 (95% CI, 1.92-2.29) and 4.09 (95% CI, 3.64-4.61) in PWoH, respectively.
Multimorbidity was associated with a higher risk of incident HF among PWH and PWoH, with more prominent associations in PWoH and certain patient subgroups. The identification of specific multimorbidity patterns that contribute to higher HF risk in PWH may lead to future preventative strategies.
研究人类免疫缺陷病毒感染者（PWH）和未感染人类免疫缺陷病毒者（PWoH）的多种疾病负担与新发心力衰竭（HF）之间的关联。
HIV-HEART研究是一项回顾性队列研究，纳入了2000年至2016年间凯撒医疗集团21岁及以上的成年PWH和PWoH。多种疾病负担由22种慢性病的基线患病率定义，并根据总体人群分布分为0 - 1种、2 - 3种以及4种及以上共病。对PWH和PWoH随访首次发生HF事件、全因死亡情况，直至2016年12月31日随访结束。使用Cox比例风险回归分别计算风险比和95%置信区间，以研究PWH和PWoH中多种疾病负担与新发HF之间的关联。
PWH（n = 38868）中0 - 1种、2 - 3种以及4种及以上共病的患病率分别为83.3%、13.0%和3.7%，PWoH（n = 386586）中分别为82.2%、14.3%和3.5%。多变量调整后，与0 - 1种共病者相比，PWH中与2 - 3种及4种及以上共病相关的新发HF风险比分别为1.33（95%置信区间，1.04 - 1.71）和2.41（95%置信区间，1.78 - 3.25），PWoH中分别为2.10（95%置信区间，1.92 - 2.29）和4.09（95%置信区间，3.64 - 4.61）。
多种疾病与PWH和PWoH中新发HF的较高风险相关，在PWoH和某些患者亚组中关联更为显著。识别导致PWH中HF风险较高的特定多种疾病模式可能会带来未来的预防策略。
