Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population
Authors: Hasse Barbara , Tarr Philip E. , Marques-Vidal Pedro , Waeber Gerard , Preisig Martin , Mooser Vincent , Valeri Fabio , Djalali Sima , Andri Rauch , Bernasconi Enos , Calmy Alexandra , Cavassini Matthias , Vernazza Pietro , Battegay Manuel , Weber Rainer , Senn Oliver , Vollenweider Peter , Ledergerber Bruno ,   the CoLaus Cohort, FIRE and the Swiss HIV Cohort Study, Aubert V , Barth J , Battegay M , Bernasconi E , Böni J , Bucher HC , Burton-Jeangros C , Calmy A , Cavassini M , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , Fux CA , Gorgievski M , Günthard H , Haerry D , Hasse B , Hirsch HH , Hösli I , Kahlert C , Kaiser L , Keiser O , Klimkait T , Kouyos R , Kovari H , Ledergerber B , Martinetti G , Martinez de Tejada B , Metzner K , Müller N , Nadal D , Pantaleo G , Rauch A , Regenass S , Rickenbach M , Rudin C , Schöni-Affolter F , Schmid P , Schultze D , Schüpbach J , Speck R , Staehelin C , Tarr P , Telenti A , Trkola A , Vernazza P , Weber R , Yerly S. , Jean-Michel Aubry , Murielle Bochud , Jean Michel Gaspoz , Christoph Hock , Thomas Lüscher , Pedro Marques Vidal , Vincent Mooser , Fred Paccaud , Martin Preisig , Peter Vollenweider , Roland Von Känel , Aidacic Vladeta , Gerard Waeber , Jürg Beriger , Markus Bertschi , Heinz Bhend , Martin Büchi , Hans-Ulrich Bürke , Ivo Bugmann , Reto Cadisch , Isabelle Charles , Corinne Chmiel , Sima Djalali , Peter Duner , Simone Erni , Andrea Forster , Markus Frei , Claudius Frey , Jakob Frey , Ali Gibreil Musa , Matthias Günthard , Denis Haller , Marcel Hanselmann , Walter Häuptli , Simon Heininger , Felix Huber , Paul Hufschmid , Eva Kaiser , Vladimir Kaplan , Daniel Klaus , Stephan Koch , Beat Köstner , Benedict Kuster , Heidi Kuster , Vesna Ladan , Giovanni Lauffer , Werner Leibundgut Hans , Phillippe Luchsinger , Severin Lüscher , Christoph Maier , Jürgen Martin , Damian Meli , Werner Messerli , Titus Morger , Valentina Navarro , Jakob Rizzi , Thomas Rosemann , Hana Sajdl , Frank Schindelek , Georg Schlatter , Oliver Senn , Pietro Somaini , Jacques Staeger , Alfred Staehelin , Alois Steinegger , Claudia Steurer , Othmar Suter , Phuoc Truong The , Marco Vecellio , Alessandro Violi , René Von Allmen , Hans Waeckerlin , Fritz Weber , Johanna Weber-Schär , Joseph Widler , Marco Zoller 
Published: July 2015

Abstract
Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population.
Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking.
Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2–2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1–2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44–1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression ide.jpegied associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5–2.4; smoking: IRR = 2.0, 95% CI = 1.6–2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9–3.8; smoking: IRR = 2.6, 95% CI = 1.9–3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4–2.4; smoking: IRR = 1.7, 95% CI = 1.4–2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus.
Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.