Table1_Changes in multimorbidity burden over a 3–5 year period among people with HIV.DOCX

Introduction: As people living with HIV age, the increasing burden of multimorbidity poses a significant health challenge. The aims of this study were to identify common patterns of multimorbidity and examine changes in their burden, as well as their associations with risk factors, over a 3–5 year period in people with HIV, enrolled in the Pharmacokinetic and clinical Observations in PeoPle over fiftY (POPPY) study.Methods: Common multimorbidity patterns were identified in POPPY participants with HIV using principal component analysis, based on Somers’ D statistic. Multimorbidity burden scores were calculated for each participant/pattern at study entry/follow-up and were standardised relative to the mean in the sample at baseline (scores >0 thus reflect a greater number of comorbidities relative to the mean). Two multivariable linear regression models were fitted to examine the associations between risk factors and burden z-scores at baseline and change in z-scores over a 3–5 year period.Results: Five patterns were identified among the 1073 POPPY participants with HIV {median age [interquartile range (IQR)], 52 (47–59) years; 85% male and 84% white}: Cardiovascular diseases (CVDs), Sexually transmitted diseases (STDs), Neurometabolic, Cancer and Mental-gastro-joint. The multivariable linear regression showed that older age, behavioural factors (i.e., body mass index (BMI), history of injection drug use, current recreational drug use and sex between men), and HIV-specific factors (i.e., duration since HIV diagnosis and a prior AIDS diagnosis) were associated with higher multimorbidity burden at baseline. However, only three of the factors (age, BMI and duration since HIV diagnosis) were significantly associated with an increase in burden across specific patterns over time.Discussion: Key modifiable and non-modifiable factors contributing to an increase in burden of multimorbidity were identified. Our findings may inform the development of more targeted interventions and guidelines to effectively prevent and manage the rising burden of multimorbidity in people with HIV.

引言：随着艾滋病患者年龄的增长，多重慢性疾病负担的日益加重构成了重大的健康挑战。本研究旨在通过分析参加五十岁以上人群药代动力学和临床观察（POPPY）研究的HIV患者，在3至5年期间识别多重慢性疾病的共同模式，考察其负担的变化及其与风险因素的相关性。方法：利用主成分分析和Somers’ D统计量，在POPPY研究的HIV患者中确定了常见的多重慢性疾病模式。对每位参与者/模式在研究入组/随访时的多重慢性疾病负担得分进行计算，并将得分标准化至基线样本的平均水平（得分大于0表明相对于平均水平的共病数量更多）。拟合了两个多变量线性回归模型，以检验风险因素与基线负担z得分以及3至5年期间z得分变化之间的关联。结果：在1073名HIV患者（中位数年龄[四分位距（IQR）]，52（47-59）岁；85%为男性，84%为白人）中，确定了五种模式：心血管疾病（CVDs）、性传播疾病（STDs）、神经代谢性疾病、癌症以及精神-胃肠-关节病。多变量线性回归分析表明，年龄增长、行为因素（即，体重指数（BMI）、注射药物使用史、当前娱乐性药物使用以及男性间的性行为）以及HIV特异性因素（即，自HIV诊断以来的持续时间以及先前AIDS诊断）与基线时的多重慢性疾病负担增加相关。然而，只有三个因素（年龄、BMI和自HIV诊断以来的持续时间）与随时间推移在特定模式下的负担增加显著相关。讨论：确定了导致多重慢性疾病负担增加的关键可调节和非可调节因素。我们的研究结果可能有助于制定更具有针对性的干预措施和指南，以有效预防和管理HIV患者中日益增长的多重慢性疾病负担。