title: The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough.
abstract: Background HIV has changed from a rapidly deteriorating illness to a complex chronic disease, with increasing incidences of comorbidity, including cancer, and liver, lung and cardiovascular diseases. North West London has 6719 individuals living with the human immunodeficiency virus (HIV), 873 of whom reside in the London Borough of Brent. Traditionally, commissioning services have focused on HIV therapy alone without considering how comorbidity affects treatment outcome and total service costs. Setting The setting for the study was NHS Brent Primary Care Trust, London UK. Question What associated comorbidities are present in people in Brent (London, UK) living with HIV, and how common are they? Methods A point-prevalence audit of retrospective data was conducted on all HIV-positive patients in Brent (financial year 2011/12). Data were collected from genito-urinary medicine (GUM) services, community services and general practitioners (GPs) on HIV diagnosis, patient demographics and past/current comorbidities: hepatitis B and C, cardiovascular disease, diabetes and mental health disorders. Results This study identified that 29% of people living with HIV/AIDS (PLWHA) in Brent have at least one comorbidity. The most common was hepatitis, followed by mental health disorders and cardiovascular disease (CVD). Comorbidity was more likely in older male patients (in particular CVD and diabetes) and White patients (except for diabetes which was more common in Asian groups). Discussion/Conclusion Many PLWHA in Brent suffer from a number of other conditions, which appear largely independent of HIV. Findings confirm the need to treat HIV as a long-term condition, including patient education, empowerment and encouraging self-management. The multi-morbidity of many PLWHA suggests a role for both primary care and collaborative, holistic, patient-centred and individualised healthcare. Service providers and commissioners need to consider comorbidities in their treatment of and provision of services for PLWHA. This study also highlighted the need for services to address limitations of their data collection systems.
authors.affiliation: Research Fellow, London South Bank University, London, UK.
authors.forename: Ava
authors.initials: A
authors.lastname: Lorenc
authors.affiliation: Clinical Research Officer.
authors.forename: Piriyankan
authors.initials: P
authors.lastname: Ananthavarathan
authors.forename: James
authors.initials: J
authors.lastname: Lorigan
authors.affiliation: Community Services Brent CCG, London, UK.
authors.forename: Mohamade
authors.initials: M
authors.lastname: Jowata
authors.affiliation: North West London Hospitals NHS Trust, London, UK.
authors.forename: Gary
authors.initials: G
authors.lastname: Brook
authors.affiliation: Director, Applied Research Unit.
authors.forename: Ricky
authors.initials: R
authors.lastname: Banarsee
keywords: AIDS; HIV; clinical audit; comorbidity