Do patterns of comorbidity vary by HIV status, age, and HIV severity?

• Authors: Joseph L. Goulet, Veterans Affairs Connecticut Healthcare System; Shawn L. Fultz, George Washington University; David Rimland, Emory University; Adeel Butt, Veterans Affairs Pittsburgh Healthcare System; Cynthia Gibert, George Washington University; Maria Rodriguez-Barradas, Michael E. De Bakey Veterans Affairs Medical Center; Kendall Bryant, National Institutes of Health; Amy C. Justice, Veterans Affairs Connecticut Healthcare System
• Journal Title: Clinical Infectious Diseases
• Volume: Volume 45, Number 12
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option C | 2007-12-15, Pages 1593-1601
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1086/523577
• Subjects: Health Sciences, Medicine and Surgery; Biology, Virology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Immunology; Infectious Diseases; Microbiology; ACTIVE ANTIRETROVIRAL THERAPY; VETERANS AGING COHORT; INFECTED VETERANS; PSYCHIATRIC COMORBIDITY; ADMINISTRATIVE DATA; POST-HAART; DISEASE; PERSPECTIVE; PROGNOSIS; ALCOHOL

Abstract

Patterns of comorbidity among persons with human immunodeficiency virus (HIV) are not well described. We compared comorbidity among veterans with and without HIV infection. The sample consisted of 33,420 HIV-infected veterans and 66,840 HIV-uninfected veterans. We identified and clustered 11 comorbid conditions using validated International Classification of Diseases, 9th Revision, Clinical Modification codes. We defined multimorbidity as the presence of conditions in all clusters. Models restricted to HIV-infected veterans were adjusted for CD4 cell count and viral load. Comorbidity was common (prevalence, 60%-63%), and prevalence varied by HIV status. Differences remained when the veterans were stratified by age. In multivariable analyses, older HIV-infected veterans were more likely to have substance use disorder and multimorbidity. Renal, vascular, and pulmonary diseases were associated with CD4 cell count <200 cells/mm3; hypertension was associated with CD4 cell count >200 cells/mm3. Comorbidity is the rule, and multimorbidity is common among veterans with HIV infection. Patterns of comorbidity differ substantially by HIV status, age, and HIV severity. Primary care guidelines require adaptation for persons with HIV infection.