Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 61, Issue 5, Pages 600-605Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAI.0b013e31827303d5
Keywords
multimorbidity; obesity; HIV; factor analysis; tetrachoric
Categories
Funding
- University of Alabama School of Medicine Center for AIDS Research [P30-AI27767]
- CNICS [1R24 AI067039-1]
- Mary Fisher CARE Fund
- National Institute on Aging [1K07AG31779, R01 AG015062]
- National Cancer Institute [UB4HP19045]
- AHRQ [R18-HS017786-02, 1R21HS019516-01]
- Agency for Healthcare Research and Quality [5 T32 HS013852]
- Bristol-Myers Squibb
- Ardea Biosciences, Inc
- Avexa Ltd
- Boehringer Ingelheim Pharmaceuticals, Inc
- Gilead Sciences, Inc
- GlaxoSmithKline
- Merck Co, Inc
- Pfizer Inc
- Tibotec Therapeutics
- Vertex Pharmaceuticals, Inc
- ViiV Healthcare
- Definicare
- Pfizer
- Merck Foundation
- AHRQ [969784, 5T32HS013852-15] Funding Source: Federal RePORTER
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Background: Increases in multimorbidity and obesity have been noted in HIV-infected populations in the current treatment era. Patterns of multimorbid disease clustering and the impact of obesity on multimorbidity are understudied in this population. Methods: We examined obesity and multimorbidity patterns among 1844 HIV-infected patients in the UAB 1917 Clinic. Exploratory factor analysis was used to identify the underlying factor structure responsible for clustering. Patterns among the resulting morbidity factors by body mass index (BMI) category were explored. Multivariable logistic regression models were fit to identify predictors of multimorbidity cluster patterns. Results: The prevalence of multimorbidity was 65% (1205/1844). Prevalence increased with progressive BMI categories from underweight (64%) to obese (79%). Three multimorbidity clusters were identified: metabolic, including hypertension, gout, diabetes mellitus, and chronic kidney disease (range, 0.41-0.84; P < 0.001); Behavioral, including mood disorders, dyslipidemia, chronic obstructive pulmonary disease, chronic ulcer disease, osteoarthritis, obstructive sleep apnea, and cardiac disorders (range, 0.32-0.57; P < 0.001); Substance Use, including alcohol abuse, substance abuse, tobacco abuse, and hepatitis C (range, 0.53-0.89; P < 0.001). Obesity was associated with increased odds of multimorbidity (obese vs. normal BMI category: OR = 1.52, 95% CI: 1.15 to 2.00). Conclusions: Three patterns of disease clustering were identified. Obesity was associated with a higher likelihood of multimorbidity. The management of multimorbidity and obesity will need to be addressed in future clinical practice guidelines to enhance long-term outcomes of HIV-infected patients in the current treatment era.
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