Changes in multimorbidity burden and their impact on patient and healthcare outcomes in people with HIV over a 3-5-year period.

BACKGROUND

Despite increasing multimorbidity among people with HIV, its impact on health outcomes over time remains uncertain. We explored how distinct multimorbidity patterns affect a broad range of health outcomes over a 3-5-year period.

METHODS

Principal component analysis (PCA) was used to identify multimorbidity patterns at baseline. Burden z -scores were calculated for each individual/pattern at baseline and a follow-up visit, and the differences in scores over time were examined. Participants completed health assessments including questionnaires [physical/mental health (SF-36)], depressive symptoms (CES-D and PHQ-9, falls, frailty and healthcare utilization), cognitive testing and pain mannequins tests. Multivariable regression models assessed associations between changes in morbidity burden z -scores and health outcomes.

RESULTS

Six multimorbidity patterns were identified in 1073 participants: " cardiovascular disease" (CVD) , " sexually transmitted infections" (STIs) , " metabolic" , " mental/joint" , " neurological" , and " cancer/other" . Subsequent analyses included 793 participants (median [interquartile range; IQR] age 53 [47-59] years; 86% male; 97% on ART) with follow up data. CVD and metabolic burden were associated with specialist appointments (CVD: β = 1.47; metabolic: β = 1.53, P  < 0.01) and ED visits (CVD: β = 1.44; metabolic: β = 1.89, P  < 0.01), mental/Joint and neurological burden with poorer physical and mental health, frailty and recurrent falls ( P  < 0.01), and cancer/other burden with higher depressive scores (β = 3.28, P  < 0.001), widespread pain (odds ratio, OR = 2.20, P  < 0.001), and hospital visits (OR = 2.31, P  < 0.001).

CONCLUSION

Distinct morbidity patterns differentially affected health outcomes and healthcare utilization over time, underscoring the need for targeted, integrated care to improve quality of life and address their complex needs.