Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population.
Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2-2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1-2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44-1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5-2.4; smoking: IRR = 2.0, 95% CI = 1.6-2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9-3.8; smoking: IRR = 2.6, 95% CI = 1.9-3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4-2.4; smoking: IRR = 1.7, 95% CI = 1.4-2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.
Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich.
Barbara
B
Hasse
Division of Infectious Diseases and Hospital Epidemiology , Kantonsspital Baselland Bruderholz, University of Basel , Bruderholz.
Philip E
PE
Tarr
Departments of Medicine, Internal Medicine.
Pedro
P
Marques-Vidal
Departments of Medicine, Internal Medicine.
Gerard
G
Waeber
Psychiatry.
Martin
M
Preisig
Pathology and Laboratory Medicine , Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois).
Vincent
V
Mooser
Institute of Primary Care, University of Zurich, University Hospital Zurich.
Fabio
F
Valeri
Institute of Primary Care, University of Zurich, University Hospital Zurich.
Sima
S
Djalali
Division of Infectious Diseases and Hospital Epidemiology , University and Inselspital Berne.
Rauch
R
Andri
Division of Infectious Diseases , Regional Hospital , Lugano.
Enos
E
Bernasconi
Division of Infectious Diseases , University Hospital Geneva.
Alexandra
A
Calmy
Division of Infectious Diseases , Centre Hospitalier Universitaire Vaudois and University of Lausanne.
Matthias
M
Cavassini
Division of Infectious Diseases and Hospital Epidemiology , Cantonal Hospital , St. Gallen.
Pietro
P
Vernazza
Division of Infectious Diseases and Hospital Epidemiology , University Hospital Basel , Switzerland.
Manuel
M
Battegay
Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich.
Rainer
R
Weber
Institute of Primary Care, University of Zurich, University Hospital Zurich.
Oliver
O
Senn
Departments of Medicine, Internal Medicine.
Peter
P
Vollenweider
Division of Infectious Diseases and Hospital Epidemiology , University of Zurich, University Hospital Zurich.
Bruno
B
Ledergerber
V
V
Aubert
J
J
Barth
M
M
Battegay
E
E
Bernasconi
J
J
Böni
H C
HC
Bucher
C
C
Burton-Jeangros
A
A
Calmy
M
M
Cavassini
M
M
Egger
L
L
Elzi
J
J
Fehr
J
J
Fellay
H
H
Furrer
C A
CA
Fux
M
M
Gorgievski
H
H
Günthard
D
D
Haerry
B
B
Hasse
H H
HH
Hirsch
I
I
Hösli
C
C
Kahlert
L
L
Kaiser
O
O
Keiser
T
T
Klimkait
R
R
Kouyos
H
H
Kovari
B
B
Ledergerber
G
G
Martinetti
B
B
Martinez de Tejada
K
K
Metzner
N
N
Müller
D
D
Nadal
G
G
Pantaleo
A
A
Rauch
S
S
Regenass
M
M
Rickenbach
C
C
Rudin
F
F
Schöni-Affolter
P
P
Schmid
D
D
Schultze
J
J
Schüpbach
R
R
Speck
C
C
Staehelin
P
P
Tarr
A
A
Telenti
A
A
Trkola
P
P
Vernazza
R
R
Weber
S
S
Yerly
Aubry
A
Jean-Michel
Bochud
B
Murielle
Gaspoz
G
Jean Michel
Hock
H
Christoph
Lüscher
L
Thomas
Marques Vidal
MV
Pedro
Mooser
M
Vincent
Paccaud
P
Fred
Preisig
P
Martin
Vollenweider
V
Peter
Von Känel
VK
Roland
Vladeta
V
Aidacic
Waeber
W
Gerard
Beriger
B
Jürg
Bertschi
B
Markus
Bhend
B
Heinz
Büchi
B
Martin
Bürke
B
Hans-Ulrich
Bugmann
B
Ivo
Cadisch
C
Reto
Charles
C
Isabelle
Chmiel
C
Corinne
Djalali
D
Sima
Duner
D
Peter
Erni
E
Simone
Forster
F
Andrea
Frei
F
Markus
Frey
F
Claudius
Frey
F
Jakob
Gibreil Musa
GM
Ali
Günthard
G
Matthias
Haller
H
Denis
Hanselmann
H
Marcel
Häuptli
H
Walter
Heininger
H
Simon
Huber
H
Felix
Hufschmid
H
Paul
Kaiser
K
Eva
Kaplan
K
Vladimir
Klaus
K
Daniel
Koch
K
Stephan
Köstner
K
Beat
Kuster
K
Benedict
Kuster
K
Heidi
Ladan
L
Vesna
Lauffer
L
Giovanni
Leibundgut Hans
LH
Werner
Luchsinger
L
Phillippe
Lüscher
L
Severin
Maier
M
Christoph
Martin
M
Jürgen
Meli
M
Damian
Messerli
M
Werner
Morger
M
Titus
Navarro
N
Valentina
Rizzi
R
Jakob
Rosemann
R
Thomas
Sajdl
S
Hana
Schindelek
S
Frank
Schlatter
S
Georg
Senn
S
Oliver
Somaini
S
Pietro
Staeger
S
Jacques
Staehelin
S
Alfred
Steinegger
S
Alois
Steurer
S
Claudia
Suter
S
Othmar
Truong The
TT
Phuoc
Vecellio
V
Marco
Violi
V
Alessandro
Von Allmen
VA
René
Waeckerlin
W
Hans
Weber
W
Fritz
Weber-Schär
WS
Johanna
Widler
W
Joseph
Zoller
Z
Marco
HIV-infection; comorbidity; multimorbidity