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Yang C, Teh YE, Chua NGS, Lee KLS, Ng RQM. An overview of multimorbidity and polypharmacy in older people living with HIV. Geriatr Gerontol Int 2024; 24 Suppl 1:49-59. [PMID: 37940135 DOI: 10.1111/ggi.14717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/10/2023]
Abstract
The availability of effective antiretroviral therapy (ART) has revolutionized the care of people living with HIV (PLHIV). As a result, PLHIV now have a life expectancy comparable with that of the general population. PLHIV are increasingly confronted with age-related comorbidities and geriatric syndromes, including frailty and polypharmacy, which occur at a higher prevalence and set in at an earlier age compared with their uninfected counterparts. The underlying pathophysiology for multimorbidity and polypharmacy are multifactorial, multidimensional and complex. Therefore, regular review and optimization of risk factors to maintain physical function, social and psychological health is of utmost importance. With an ever-growing population of older PLHIV, there is a pressing need to provide holistic care to address these emerging issues. Accelerated aging observed in PLHIV suggests that early involvement of a multidisciplinary team, including geriatricians, and implementation of integrated models of care can potentially improve the care of older PLHIV, who are at increased risk of frailty and complex multimorbidity. This article reviews the current global situation, discusses the challenges involved and suggests approaches to deliver comprehensive care for older PLHIV. Geriatr Gerontol Int 2024; 24: 49-59.
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Affiliation(s)
- Chen Yang
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
| | - Yii Ean Teh
- Department of Infectious Disease, Singapore General Hospital, Outram Road, Singapore
| | | | | | - Rachel Qiao Ming Ng
- Department of Geriatric Medicine, Singapore General Hospital, Outram Road, Singapore
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Mefford MT, Silverberg MJ, Leong TK, Hechter RC, Towner WJ, Go AS, Horberg M, Hu H, Harrison TN, Sung SH, Reynolds K. Multimorbidity Burden and Incident Heart Failure Among People With and Without HIV: The HIV-HEART Study. Mayo Clin Proc Innov Qual Outcomes 2022; 6:218-227. [PMID: 35539894 PMCID: PMC9079699 DOI: 10.1016/j.mayocpiqo.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective To examine the association between multimorbidity burden and incident heart failure (HF) among people with HIV (PWH) and people without HIV (PWoH). Patients and Methods The HIV-HEART study is a retrospective cohort study that included adult PWH and PWoH aged 21 years or older at Kaiser Permanente between 2000 and 2016. Multimorbidity burden was defined by the baseline prevalence of 22 chronic conditions and was categorized as 0-1, 2-3, and 4 or more comorbidities on the basis of distribution of the overall population. People with HIV and PWoH were followed for a first HF event, all-cause death, or up to the end of follow-up on December 31, 2016. Using Cox proportional hazard regression, hazard ratios and 95% CIs were calculated to examine the association between multimorbidity burden and incident HF among PWH and PWoH, separately. Results The prevalences of 0-1, 2-3, and 4 or more comorbidities were 83.3%, 13.0%, and 3.7% in PWH (n=38,868), and 82.2%, 14.3%, and 3.5% in PWoH (n=386,586), respectively. After multivariable adjustment, compared with people with 0-1 comorbidities, the hazard ratios of incident HF associated with 2-3 and 4 or more comorbidities were 1.33 (95% CI, 1.04-1.71) and 2.41 (95% CI, 1.78-3.25) in PWH and 2.10 (95% CI, 1.92-2.29) and 4.09 (95% CI, 3.64-4.61) in PWoH, respectively. Conclusion Multimorbidity was associated with a higher risk of incident HF among PWH and PWoH, with more prominent associations in PWoH and certain patient subgroups. The identification of specific multimorbidity patterns that contribute to higher HF risk in PWH may lead to future preventative strategies.
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Affiliation(s)
- Matthew T Mefford
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Thomas K Leong
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Rulin C Hechter
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Epidemiology, University of California Los Angeles, Los Angeles, CA
| | - William J Towner
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Clinical Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Department of Infectious Disease, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Departments of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA.,Department of Medicine, University of California, San Francisco, CA.,Department of Medicine, Stanford University, Palo Alto, CA
| | - Michael Horberg
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.,Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Haihong Hu
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | - Teresa N Harrison
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.,Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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