Patterns of Co-occurring Comorbidities in People Living With HIV
Authors: De Francesco Davide , Verboeket Sebastiaan O , Underwood Jonathan , Bagkeris Emmanouil , Wit Ferdinand W , Mallon Patrick W G , Winston Alan , Reiss Peter , Sabin Caroline A ,   Pharmacokinetic and Clinical Observations in PeoPle Over fiftY (POPPY) study and the AGEhIV Cohort Study, Babalis Daphne , Boffito Marta , Burgess Laura , Mallon Paddy , Post Frank , Sabin Caroline A , Sachikonye Memory , Winston Alan , Anderson Jane , Asboe David , Boffito Marta , Garvey Lucy , Mallon Paddy , Post Frank , Pozniak Anton , Sabin Caroline A , Sachikonye Memory , Vera Jaime , Williams Ian , Winston Alan , Clarke Amanda , Vera Jaime , Bexley Andrew , Richardson Celia , Kirk Sarah , Gleig Rebecca , Boffito Marta , Asboe David , Pozniak Anton , Bracchi Margherita , Pagani Nicole , Cerrone Maddalena , Bradshaw Daniel , Ferretti Francesca , Higgs Chris , Seah Elisha , Fletcher Stephen , Anthonipillai Michelle , Moyes Ashley , Deats Katie , Syed Irtiza , Matthews Clive , Fernando Peter , Chiwome Chido , Hardwick Shane , Anderson Jane , Mguni Sifiso , Clark Rebecca , Nevin-Dolan Rhiannon , Pelluri Sambasivarao , Post Frank , Campbell Lucy , Yurdakul Selin , Okumu Sara , Pollard Louise , Santana-Suarez Beatriz , Mallon Paddy , Macken Alan , Ghavani-Kia Bijan , Maher Joanne , Byrne Maria , Flaherty Ailbhe , Babu Sumesh , Williams Ian , Otiko Damilola , Phillips Laura , Laverick Rosanna , Beynon Michelle , Salz Anna-Lena , Severn Abigail , Winston Alan , Garvey Lucy , Underwood Jonathan , Tembo Lavender , Stott Matthew , McDonald Linda , Dransfield Felix , Whitehouse Andrew , Burgess Laura , Babalis Daphne , Johnson Margaret , Ngwu Nnenna , Hemat Nargis , Jones Martin , Carroll Anne , Kinloch Sabine , Youle Mike , Madge Sara , Sabin Caroline A , Francesco Davide De , Bagkeris Emmanouil , Reiss P , Wit F W N M , van der Valk M , Schouten J , Kooij K W , van Zoest R A , Verheij E , Verboeket S O , Elsenga B C , Prins M , van der Loeff M F Schim , Grande L del , Olthof V , Dijkstra M , Zaheri S , Hillebregt M M J , Ruijs Y M C , Benschop D P , Berkaoui A el , Kootstra N A , Harskamp-Holwerda A M , Maurer I , Ruiz M M Mangas , Girigorie A F , Boeser-Nunnink B , Zikkenheiner W , Janssen F R , Geerlings S E , Goorhuis A , Hovius J W R , Nellen F J B , van der Poll T , Prins J M , Reiss P , van der Valk M , Wiersinga W J , van Vugt M , Bree G de , Wit F W N M , van Eden J , van Hes A M H , Pijnappel F J J , Weijsenfeld A , Smalhout S , van Duinen M , Hazenberg A , Postema P G , Bisschop P H L T , Serlie M J M , Lips P , Dekker E , van der Velde N , Willemsen J M R , Vogt L , Schouten J , Portegies P , Schmand B A , Geurtsen G J , Verbraak F D , Demirkaya N , Visser I , Schadé A , Nieuwkerk P T , Langebeek N , van Steenwijk R P , Dijkers E , Majoie C B L M , Caan M W A , van Lunsen H W , Nievaard M A F , van den Born B J H , Stroes E S G , Mulder W M C , van Oorspronk S 
Published: October 2018

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 &lt; .001). The mental health pattern was correlated with all the other patterns (in particular cancers: r = .20; chest/other infections: r = .27; both P &lt; .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 &lt; .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.