319. High Rates of Developing Multimorbidity Shortly After HIV-Seroconversion
Session: Poster Abstract Session: HIV Co-morbidities
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDCRP_Multimorbidity Poster IDSA FINAL3.pdf (242.3 kB)
  • Background: HIV-infected persons are at increased risk for age-related, non-AIDS-defining conditions.  The development of multimorbidity, defined as the presence two or more chronic conditions, has not been evaluated among a young cohort of recently diagnosed HIV seroconverters with open access to care.

    Methods: Documented HIV-seroconverters as part of the US Military HIV Natural History Study were evaluated (2000-2012).  All participants had a seroconverting window <2 years, were enrolled within 6 months of first HIV positive test, and were active duty servicemembers.   Multimorbidity was defined as two or more chronic medical conditions prospectively diagnosed during six-month study visits; conditions predating the first HIV-positive test result were excluded.  Statistical analyses included Cox Proportional models with hazards ratios (HR) and 95% confidence intervals (CI).

    Results:  Of 630 HIV-infected persons, 133 (21%) developed multimorbidity over a mean 3-year period.  The median (IQR) age at baseline (HIV diagnosis) of the cohort was 26 (23, 33) years; 97% were male; race was 40% African American, 39% Caucasian, and 21% Hispanic/other; median (IQR) CD4 of at baseline 486 (371, 628) cells/mm3, and 88% began antiretroviral therapy during follow-up.  The most common disorders contributing to multimorbidity were hyperlipidemia, hypertension,  degenerative arthropathy, gastroesophageal reflux disease, mental health conditions (e.g., depression, anxiety) and alcohol abuse.  In the multivariate model, lower CD4 counts (HR 0.96 per 100 cells, 95% CI 0.92-0.99), higher HIV RNA (HR 1.13 per log VL, 95% CI 1.05-1.22), and prior AIDS (HR 2.15, 95% CI 1.33-3.48) were associated with multimorbidity.  In addition, being obese (1.64, 95% CI 1.30-2.06) or overweight (HR 1.25, 95% CI 1.04-1.49) compared to normal weight was associated with multimorbidity.

    Conclusion: Multimorbidity was common among a young cohort of HIV seroconverters with recently diagnosed HIV.  Improved HIV control and optimal weight were associated with a decreased risk for multimorbidity.  Preventive and early management strategies for comorbid conditions should be implemented among HIV patients.

    Nancy Crum-Cianflone, MD MPH1,2,3, Octavio Mesner, MS2, Ionut Bebu, PhD4, Anuradha Ganesan, MD2, Edmund Tramont, MD5 and Brian Agan, MD2, (1)Naval Medical Center San Diego, San Diego, CA, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (3)Naval Health Research Center, San Diego, CA, (4)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Rockville, MD, (5)National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, MD

    Disclosures:

    N. Crum-Cianflone, None

    O. Mesner, None

    I. Bebu, None

    A. Ganesan, None

    E. Tramont, None

    B. Agan, None

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