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，多重慢性疾病的负担日益加重，对公共卫生构成了重大挑战。本研究旨在通过分析参与五十五岁以上人群药代动力学与临床观察（POPPY）研究的艾滋病患者的数据，识别多重慢性疾病的常见模式，并探讨其负担的变化及其与风险因素在3-5年期间的关系。方法：利用主成分分析，基于Somers’ D统计量，在POPPY研究中识别了艾滋病患者的常见多重慢性疾病模式。为每位参与者/模式在研究开始/随访时计算多重慢性疾病负担得分，并将其标准化，相对于基线样本均值（得分大于0，因此反映的共病数量相对于均值更多）。拟合了两个多变量线性回归模型，以检查风险因素与基线负担z得分以及3-5年期间z得分变化之间的关系。结果：在1073名POPPY艾滋病参与者中（中位年龄[四分位距（IQR）]，52（47-59）岁；85%为男性，84%为白人）识别出五种模式：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-关节疾病。多变量线性回归分析显示，年龄增长、行为因素（即体质指数（BMI）、注射药物使用史、当前娱乐药物使用以及男性之间的性行为）以及艾滋病特异性因素（即自艾滋病诊断以来的持续时间以及既往艾滋病诊断）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以及自艾滋病诊断以来的持续时间）与特定模式随时间推移的负担增加显著相关。讨论：识别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为开发更具针对性的干预措施和指南提供信息，以有效预防和管理艾滋病患者的多重慢性疾病负担的增加。