Having two or more chronic health conditions at the same time, such as hyperlipidemia, hypertension and major depression, is common in young adults shortly after HIV infection, but early initiation of highly active antiretroviral therapy (HAART) and optimization of healthy behaviors may be helpful in preventing this multimorbidity, according to study results presented at IDWeek 2013, in San Francisco.
It is unclear why HIV-infected patients experience an increased prevalence and early onset of simultaneous, non-AIDS-defining medical conditions, but past research suggests that it may be related to inflammation, immunosenescence (gradual deterioration of the immune system), psychological stressors and other behavioral risk factors. The development of multimorbidity, defined as the co-occurrence of two or more chronic health conditions, is increasingly recognized in HIV-infected patients and may be associated with decreased functional status, increased medical costs, and mortality.
To evaluate the prevalence and factors behind multimorbidity, Nancy F. Crum-Cianflone, M.D., M.P.H., and colleagues evaluated data from 2000-2012 on 630 HIV-infected patients in the U.S. Military Natural History Study (NHS). All participants had been living with HIV for less than two years, with enrollment into the NHS within six months after diagnosis. The group was predominantly male (97%), racially mixed (40% black, 39% white/non-Hispanic and 21% Hispanic/other) and had a median age of 26 years at baseline (HIV diagnosis). The median baseline CD4+ cell count was 486 cells/mm3 and 88% began antiretroviral therapy during follow up.
Chronic health conditions that predated HIV diagnosis were excluded to focus on those occurring after infection. Factors associated with multimorbidity were assessed, including age, gender, race/ethnicity, tobacco use, body mass index (BMI) over time, use of HAART over time, CD4+ cell count over time and viral loads over time.
Of the 630 participants, the researchers found that 133 (21%) had developed multimorbidity over an average period of three years after diagnosis. The most common conditions were hyperlipidemia, hypertension, mental health conditions (such as major depression and anxiety) and gastroesophageal reflux disease (GERD).
Additionally, lower CD4+ cell counts (HR 0.96 per 100 cells, 95% CI 0.92-0.99), higher viral loads (HR 1.13 per log VL, 95% CI 1.05-1.22), AIDS diagnosis (HR 2.15, 95% CI 1.33-3.48) and being overweight (HR 1.25, 95% CI 1.04-1.49) or obese (HR 1.64, 95% CI 1.30-2.06) were also associated with multimorbidity, as shown by Cox models.
According to Crum-Cianflone and her group, multimorbidity was common early after HIV infection among young adults and improved HIV control and optimal weight were associated with a decreased risk for multiple concurrent health conditions. Therefore, the researchers concluded that early initiation of HAART and optimization of healthy behaviors, such as weight management, may be helpful in preventing multimorbidity among HIV-infected patients. The researchers also believe that future prospective studies are needed to examine the impact of therapeutic interventions.
Fred Furtado is a science writer based in Rio de Janeiro, Brazil.
Follow Fred on Twitter: @Patchlord.