Casten Michael, Herbert Simone, Smith David J, Petoumenos Kathy, Coorey Craig, Edmiston Natalie
Western Sydney University School of Medicine, Sydney, Australia.
North Coast Sexual Health Services, MNCLHD NSW, Port Macquarie, Australia.
HIV Med. 2023 Jul;24(7):807-817. doi: 10.1111/hiv.13483. Epub 2023 Mar 16.
Multimorbidity is common among people living with HIV (PLWH), with numerous cross-sectional studies demonstrating associations with older age and past immunosuppression. Little is known about the progression of multimorbidity, particularly in the setting of long-term access to antiretrovirals. This study aims to determine factors predictive of change in multimorbidity in PLWH.
People living with HIV who attended a regional HIV service were recruited to a consented observational cohort between September 2016 and March 2020. Demographic data, laboratory results and a Cumulative Illness Rating Scale (CIRS) were collected at enrolment and first clinical review of every subsequent year. Change in CIRS score was calculated from enrolment to February 2021. Associations with change were determined through univariate and multivariate linear regression.
Of 253 people, median age was 58.9 [interquartile range (IQR): 51.9-64.4] years, 91.3% were male, and HIV was diagnosed a median of 22.16 years (IQR: 12.1-30.9) beforehand. Length of time in the study was a median of 134 weeks (IQR: 89.0-179.0), in which a mean CIRS score change of 1.21 (SD 2.60) was observed. Being older (p < 0.001) and having a higher body mass index (p = 0.008) and diabetes (p = 0.014) were associated with an increased likelihood of worsening multimorbidity. PLWH with a higher level of multimorbidity at baseline were less likely to worsen over time (p < 0.001).
As diabetes and weight predict worsening multimorbidity, routine diabetes screening, body mass index measurement, and multimorbidity status awareness are recommended.
多重疾病在艾滋病毒感染者（PLWH）中很常见，大量横断面研究表明其与年龄较大和既往免疫抑制有关。关于多重疾病的进展情况，人们了解甚少，尤其是在长期可获得抗逆转录病毒药物的情况下。本研究旨在确定艾滋病毒感染者多重疾病变化的预测因素。
2016年9月至2020年3月期间，招募了在地区艾滋病毒服务机构就诊的艾滋病毒感染者进入一个经同意的观察性队列。在入组时以及随后每年的首次临床复查时收集人口统计学数据、实验室检查结果和累积疾病评定量表（CIRS）。计算从入组到2021年2月CIRS评分的变化。通过单变量和多变量线性回归确定与变化的关联。
在253人中，中位年龄为58.9岁[四分位间距（IQR）：51.9 - 64.4]，91.3%为男性，艾滋病毒感染的诊断时间中位数为22.16年（IQR：12.1 - 30.9）。研究时间中位数为134周（IQR：89.0 - 179.0），在此期间观察到CIRS评分平均变化为1.21（标准差2.60）。年龄较大（p < 0.001）、体重指数较高（p = 0.008）和患有糖尿病（p = 0.014）与多重疾病恶化的可能性增加相关。基线时多重疾病水平较高的艾滋病毒感染者随着时间推移恶化的可能性较小（p < 0.001）。
由于糖尿病和体重可预测多重疾病恶化，建议进行常规糖尿病筛查、测量体重指数并了解多重疾病状况。
