Non-HIV co-morbidity: identification of patients at risk is needed

  • Daniela Ovadia — Agenzia Zoe
  • Medical News
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Key messages

  • In an Italian cohort of persons living with HIV infection (PLWH) with a mean age lower than 50, about 82% have co-morbidity and 50% have multi-morbidity.
  • The most frequent co-morbidity is dyslipidaemia and is associated with many different variables.
  • Identification of common patterns may help to identify the combined risks of multiple drug and disease-disease interactions.

In recent years, the prevalence of co-morbidities among persons living with HIV infection (PLWH) has increased. A cross-sectional study, conducted by the Italian Group for the Study of Allergies and Infections in HIV, from a group of Italian PLWH, was designed to describe the pattern of co-morbidity and multi-morbidity by age class, their clustering mode and the potential disease-disease interactions.

Out of 1,087 participants (mean age 47.9 ±10.8), 285 (26.2%) had one condition and 612 (56.3%) were multi-morbid (25.3% had two comorbidities, 19.3% three, 8.2% four and 3.5% five or more).

The most frequent co-morbidity was dyslipidaemia (55.3%), whereas the recurrent associations were dyslipidaemia + hypertension (n=237, 21.8%), followed by dyslipidaemia + chronic obstructive pulmonary disease (COPD) (n=188, 17.3%) and COPD + antibodies for hepatitis C virus (n=141, 12.9%).

Multi-morbid patients were older, with a lower nadir CD4 cell count, a longer period under antiretroviral therapy and had higher triglycerides, glycaemia, and total cholesterol. Further, multi-morbidity was associated with higher body mass index and current and former smoking, as well as with CDC (Center for Diseases Control) stage C.

Among subjects with dyslipidaemia (n=601) or those with high blood pressure (n=341), 76% and 39% respectively, were without treatment for their comorbidities. In both conditions, older patients (≥65 years old) were more likely to be treated than younger ones.

This type of investigation could support the development of intervention models, improve the management of multi-morbid patients, and provide indications for prevention of multiple co-morbidities in PLWH. Moreover, the evaluation of common patterns of co-morbidities may help to identify the combined risks of therapeutic conflicts in this population and to adapt clinical practice guideline recommendations.

Limitations: absence of a control group (HIV-negative subjects); polypharmacy was not evaluated.