Sukumaran Luxsena, De Francesco Davide, Winston Alan, Mallon Patrick W G, Doyle Nicki, Anderson Jane, Boffito Marta, Williams Ian, Post Frank A, Vera Jaime, Sachikonye Memory, Johnson Margaret A, Sabin Caroline A
Institute for Global Health, University College London, London, United Kingdom.
National Institute for Health and Care Research (NIHR) Health Protection Research Unit (HPRU) in Blood Borne and Sexually Transmitted Infections at University College London, London, United Kingdom.
Front Syst Biol. 2023 Feb 27;3:1136999. doi: 10.3389/fsysb.2023.1136999. eCollection 2023.
As people living with HIV age, the increasing burden of multimorbidity poses a significant health challenge. The aims of this study were to identify common patterns of multimorbidity and examine changes in their burden, as well as their associations with risk factors, over a 3-5 year period in people with HIV, enrolled in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study. Common multimorbidity patterns were identified in POPPY participants with HIV using principal component analysis, based on Somers' D statistic. Multimorbidity burden scores were calculated for each participant/pattern at study entry/follow-up and were standardised relative to the mean in the sample at baseline (scores >0 thus reflect a greater number of comorbidities relative to the mean). Two multivariable linear regression models were fitted to examine the associations between risk factors and burden z-scores at baseline and change in z-scores over a 3-5 year period. Five patterns were identified among the 1073 POPPY participants with HIV {median age [interquartile range (IQR)], 52 (47-59) years; 85% male and 84% white}: Cardiovascular diseases (CVDs), Sexually transmitted diseases (STDs), Neurometabolic, Cancer and Mental-gastro-joint. The multivariable linear regression showed that older age, behavioural factors (i.e., body mass index (BMI), history of injection drug use, current recreational drug use and sex between men), and HIV-specific factors (i.e., duration since HIV diagnosis and a prior AIDS diagnosis) were associated with higher multimorbidity burden at baseline. However, only three of the factors (age, BMI and duration since HIV diagnosis) were significantly associated with an increase in burden across specific patterns over time. Key modifiable and non-modifiable factors contributing to an increase in burden of multimorbidity were identified. Our findings may inform the development of more targeted interventions and guidelines to effectively prevent and manage the rising burden of multimorbidity in people with HIV.
随着感染艾滋病毒的人群年龄增长，多种疾病并存的负担日益加重，这对健康构成了重大挑战。本研究的目的是确定多种疾病并存的常见模式，研究其负担的变化，以及在参加“五十岁以上人群的药代动力学和临床观察”（POPPY）研究的艾滋病毒感染者中，这些模式在3至5年期间与风险因素的关联。基于萨默斯D统计量，使用主成分分析在POPPY研究的艾滋病毒感染者中确定了常见的多种疾病并存模式。在研究开始/随访时为每个参与者/模式计算多种疾病并存负担得分，并相对于基线时样本中的平均值进行标准化（得分>0因此反映相对于平均值有更多的合并症）。拟合了两个多变量线性回归模型，以研究风险因素与基线时负担z分数之间的关联，以及3至5年期间z分数的变化。在1073名POPPY研究的艾滋病毒感染者中确定了五种模式{中位年龄[四分位间距（IQR）]，52（47 - 59）岁；85%为男性，84%为白人}：心血管疾病（CVD）、性传播疾病（STD）、神经代谢疾病、癌症和精神-胃肠-关节疾病。多变量线性回归显示，年龄较大、行为因素（即体重指数（BMI）注射吸毒史、当前使用消遣性药物和男性之间的性行为）以及艾滋病毒特异性因素（即自艾滋病毒诊断以来的持续时间和先前的艾滋病诊断）与基线时较高的多种疾病并存负担相关。然而，随着时间的推移，只有三个因素（年龄、BMI和自艾滋病毒诊断以来的持续时间）与特定模式下负担的增加显著相关。确定了导致多种疾病并存负担增加的关键可改变和不可改变因素。我们的研究结果可能为制定更具针对性的干预措施和指南提供信息，以有效预防和管理艾滋病毒感染者中不断上升的多种疾病并存负担。
