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

Abstract

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 utilisation), 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 (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 utilisation over time, underscoring the need for targeted, integrated care to improve quality of life and address their complex needs.