Multiple Morbidity Is Common in HIV Positive U.S. Veterans

HIV positive U.S. veterans commonly have multiple co-existing conditions, according to a report in the December 15, 2008 issue of Clinical Infectious Diseases.

Researchers with the Veterans Administration (VA) health system compared comorbidity among patients with and without HIV infection. The sample consisted of 33,420 HIV positive and 66,840 HIV negative veterans.

The researchers identified and clustered 11 comorbid conditions using validated International Classification of Diseases (9th Revision) Clinical Modification codes. They defined “multi-morbidity” as the presence of conditions from all clusters. Among the HIV positive subjects, analyses were adjusted for CD4 cell count and viral load.

Results

• Comorbidity was common, with a prevalence of 60%-63%.

• Prevalence varied by HIV status.

• Differences in comorbidity prevalence remained after the veterans were stratified by age.

• In multivariable analyses, older HIV positive veterans were more likely to have a substance use disorder and multi-morbidity.

• Renal (kidney), vascular, and pulmonary disease were associated with having a CD4 cell count below 200 cells/mm³.

• Hypertension (high blood pressure) was associated with having a CD4 cell count above 200 cells/mm³.

Conclusion

“Comorbidity is the rule, and multi-morbidity is common among veterans with HIV infection,” the authors concluded. “Patterns of comorbidity differ substantially by HIV status, age, and HIV severity. Primary care guidelines require adaptation for persons with HIV infection.”