Disproportionate vulnerability to and unique aggregation pattern of non-AIDS comorbidities among women with HIV in China
Xiaoxiao Chen, Congcong Guo, Tingting Wang, Weiwei Shen, Shanling Wang, Yating Wang, Tailin Chen, Miaochen Wang, Haijiang Lin, Na HeAbstract
Background
Whether and how sex plays differential roles in aging-related multimorbidity among people with HIV (PWH) is poorly characterized.
Methods
We included 2479 PWH and 5376 people without HIV (PWoH) from the baseline assessment of the Comparative HIV and Aging Research in Taizhou (CHART) cohort. Ten non-AIDS comorbidities (NACM) were investigated. Multiple logistic regression was used to assess the correlates of multimorbidity (defined as the coexistence of ≥2 NACM). Multimorbidity patterns were identified through hierarchical cluster analysis.
Results
The prevalence of multimorbidity was higher in PWH than in PWoH (74.6% vs. 66.9%, p < 0.001). This difference was particularly pronounced in women in each of the age groups from 18 through 59 years and among men in each of the age groups from 18 through 49 years. A significant interaction between sex and HIV on multimorbidity was identified (p < 0.001), with the strength of the association between HIV infection and multimorbidity being stronger in women than in men. Women with HIV presented a unique aggregation pattern of multimorbidity, where neuropsychiatric disorders (depression, neurocognitive impairment) clustered with cardiometabolic diseases. In contrast, all men and women without HIV manifested a similar multimorbidity pattern, where depression and neurocognitive impairment were clustered with hematologic abnormalities but not with cardiometabolic diseases.
Conclusions
Earlier onset and higher burden of multimorbidity in PWH, as well as disproportionate vulnerability to and unique multimorbidity pattern among women with HIV, underscore the urgent need for early and sexually-oriented integrative interventions and health services targeting multimorbidity in PWH.