title: Aging and infectious diseases: do patterns of comorbidity vary by HIV status, age, and HIV severity?
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/mm(3); hypertension was associated with CD4 cell count >200 cells/mm(3). 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.
authors.affiliation: Veterans Affairs Connecticut Healthcare System, West Haven, CT 06516, USA. joseph.goulet@med.va.gov
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Goulet
authors.forename: Shawn L
authors.initials: SL
authors.lastname: Fultz
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.forename: Adeel
authors.initials: A
authors.lastname: Butt
authors.forename: Cynthia
authors.initials: C
authors.lastname: Gibert
authors.forename: Maria
authors.initials: M
authors.lastname: Rodriguez-Barradas
authors.forename: Kendall
authors.initials: K
authors.lastname: Bryant
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D014728:Veterans; D019562:Viral Load