In contrast to co-morbidity, multimorbidity among people living with HIV has not been well studied. Multimorbidity is the co-occurrence of more than one chronic health condition in addition to HIV. Higher multimorbidity increases mortality, complexity of care and health care costs while decreasing quality of life. Our aim was to describe the prevalence of and factors associated with multimorbidity among HIV positive patients attending a regional sexual health service.
We conducted a record review of all HIV positive patients attending a regional sexual health service between 1/7/2011 and 30/6/2012. Sociodemographic, general health and HIV related data were collected. Two medical officers reviewed records for chronic health conditions and to rate multimorbidity using the Cumulative Illness Rating Scale (CIRS). We used univariate and multivariate linear regression analyses to determine factors associated with higher CIRS score.
189 individuals were included in the study, the mean age was 51.8 yrs and 92.6% were men. One quarter (25.4%) had ever been diagnosed with AIDS and almost all (94.2%) were prescribed antiretrovirals. Multimorbidity was extremely common with 54.5% of individuals having 2 or more chronic health conditions in addition to HIV, the most common being a mental health diagnosis, followed by vascular disease. In multivariate analysis, older age, having ever been diagnosed with AIDS and being on ARV regimen other than 2 nucleosides and NNRTI or PI were associated with higher CIRS score. Current CD4 count, current viral load and body mass index were not associated with multimorbidity.
This study highlights high levels of multimorbidity among HIV positive patients. To our knowledge it is the only study looking at associations with multimorbidity in the Australian setting and it identifies 2 important factors, age and ever having AIDS. Care models for HIV positive patients should include assessing and managing multimorbidity particularly in older people and those that have ever been diagnosed with AIDS.
Disclosure of Interest: D. Smith is on the advisory board for Boehringer Ingelheim. D. Smith and N. Edmiston have received travel grants from commercial entities to attend educational meetings. No pharmaceutical grants were received in the development of this study.
Staff specialist at Lismore Sexual Health Service, Natalie Edmiston has worked in HIV medicine and sexual health in a number of regional areas and has a particular interest in developing local research, NSW, Australia.
Co-authors: E. Passmore2, D. Smith1, K. Petoumenos3. 1- Lismore Sexual Health Service. 2- Centre for Epidemiology and Evidence, NSW Ministry of Health. 3- Kirby institute for Infection and immunity in society, University of NSW.