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Patterns of Co-occurring Comorbidities in People Living With HIV

2018; Oxford University Press; Volume: 5; Issue: 11 Linguagem: Inglês

10.1093/ofid/ofy272

2328-8957

Davide De Francesco, Sebastiaan O Verboeket, Jonathan Underwood, Emmanouil Bagkeris, Ferdinand W.N.M. Wit, Patrick Mallon, Alan Winston, Peter Reiss, Caroline Sabin, Daphne Babalis, Marta Boffito, Laura Burgess, Patrick Mallon, Frank Post, Caroline Sabin, Memory Sachikonye, Alan Winston, Jane Anderson, David Asboe, Marta Boffito, Lucy Garvey, Patrick Mallon, Frank Post, Anton Pozniak, Caroline Sabin, Memory Sachikonye, Jaime H. Vera, Ian Williams, Alan Winston, Amanda Clarke, Jaime H. Vera, Andrew Bexley, Celia Richardson, Sara Kirk, Rebecca Gleig, Marta Boffito, David Asboe, Anton Pozniak, Margherita Bracchi, Nicole Pagani, Maddalena Cerrone, Daniel Bradshaw, Francesca Ferretti, Chris Higgs, Elisha Seah, Stephen Fletcher, Michelle Anthonipillai, Ashley Moyes, Katie Deats, Irtiza Syed, Clive Matthews, Peter Fernando, Chido Chiwome, S. W. Hardwick, Jane Anderson, Sifiso Mguni, Rebecca Clark, Rhiannon Nevin-Dolan, Sambasivarao Pelluri, Frank Post, Lucy J. Campbell, Selin Yurdakul, Sara Okumu, Louise Pollard, Beatriz Santana-Suarez, Patrick Mallon, Alan Macken, Bijan Ghavani-Kia, Joanne Maher, M. M. Byrne, Ailbhe Flaherty, Sumesh Babu, Ian Williams, Damilola Otiko, Laura L. Phillips, Rosanna Laverick, Michelle Beynon, Anna-Lena Salz, Abigail Severn, Alan Winston, Lucy Garvey, Jonathan Underwood, Lavender Tembo, Matthew A. Stott, Linda McDonald, Felix Dransfield, Andrew J. O. Whitehouse, Laura Burgess, Daphne Babalis, Margaret Johnson, Nnenna Ngwu, Nargis Hemat, Martin Jones, Anne Carroll, Sabine Kinloch, Mike Youle, Sara Madge, Caroline Sabin, Davide De Francesco, Emmanouil Bagkeris, P Reiss, F W N M Wit, Marc van der Valk, J. Schouten, Katherine W. Kooij, Rosan A van Zoest, Elwin Verheij, Sebastiaan O Verboeket, B C Elsenga, Maria Prins, Maarten F. Schim van der Loeff, L del Grande, V Olthof, Maartje Dijkstra, S Zaheri, M M J Hillebregt, Y M C Ruijs, D P Benschop, A el Berkaoui, Neeltje A. Kootstra, A M Harskamp-Holwerda, Iris Maurer, M M Mangas Ruiz, A F Girigorie, Brigitte Boeser‐Nunnink, W Zikkenheiner, F R Janssen, Suzanne E. Geerlings, Abraham Goorhuis, Joppe W. Hovius, F.J.B. Nellen, Tom van der Poll, Jan M. Prins, P Reiss, Marc van der Valk, W. Joost Wiersinga, M. van Vugt, Godelieve de Bree, F W N M Wit, J. van Eden, A M H van Hes, F J J Pijnappel, Annouschka M. Weijsenfeld, S Smalhout, Marlies van Duinen, Anda Hazenberg, Pieter G. Postema, P H L T Bisschop, Mireille J. Serlie, Paul Lips, E Dekker, Nathalie van der Velde, J M R Willemsen, Liffert Vogt, J. Schouten, Peter Portegies, Ben Schmand, Gert J. Geurtsen, Frank D. Verbraak, Nazli Demirkaya, Ingmar Visser, Annemiek Schadé, Pythia T. Nieuwkerk, Nienke Langebeek, Reindert P. van Steenwijk, Erica Dijkers, Charles B.L.M. Majoie, Matthan W.A. Caan, H.W. van Lunsen, M A F Nievaard, Bert‐Jan H. van den Born, Erik S.G. Stroes, W. Mulder, S van Oorspronk,

Pneumocystis jirovecii pneumonia detection and treatment

Abstract Background The aims of this study were to identify common patterns of comorbidities observed in people living with HIV (PLWH), using a data-driven approach, and evaluate associations between patterns identified. Methods A wide range of comorbidities were assessed in PLWH participating in 2 independent cohorts (POPPY: UK/Ireland; AGEhIV: Netherlands). The presence/absence of each comorbidity was determined using a mix of self-reported medical history, concomitant medications, health care resource use, and laboratory parameters. Principal component analysis (PCA) based on Somers’ D statistic was applied to identify patterns of comorbidities. Results PCA identified 6 patterns among the 1073 POPPY PLWH (85.2% male; median age [interquartile range {IQR}], 52 [47–59] years): cardiovascular diseases (CVDs), sexually transmitted diseases (STDs), mental health problems, cancers, metabolic disorders, chest/other infections. The CVDs pattern was positively associated with cancer (r = .32), metabolic disorder (r = .38), mental health (r = .16), and chest/other infection (r = .17) patterns (all P < .001). The mental health pattern was correlated with all the other patterns (in particular cancers: r = .20; chest/other infections: r = .27; both P < .001). In the 598 AGEhIV PLWH (87.6% male; median age [IQR], 53 [48–59] years), 6 patterns were identified: CVDs, chest/liver, HIV/AIDS events, mental health/neurological problems, STDs, and general health. The general health pattern was correlated with all the other patterns (in particular CVDs: r = .14; chest/liver: r = .15; HIV/AIDS events: r = .31; all P < .001), except STDs (r = –.02; P = .64). Conclusions Comorbidities in PLWH tend to occur in nonrandom patterns, reflecting known pathological mechanisms and shared risk factors, but also suggesting potential previously unknown mechanisms. Their identification may assist in adequately addressing the pathophysiology of increasingly prevalent multimorbidity in PLWH.