Functional and High-Risk Comorbidities in PLWH
For people living with HIV (PLWH), comorbidities account for a large part of their disease burden and, therefore, their management plans. However, the focus of these comorbidities by researchers often fails to include sufficient consideration for functional comorbidities. To provide well-rounded care for PLWH, health care providers must consider the impact of both high-risk and functional comorbidities over the course of their patients’ lives.
The authors of a recent study aimed to examine the relationship between these multimorbidities and determine their prevalence in this patient population. To learn more about these findings, Consultant360 reached out to lead author Eugenia Siegler, MD, who is a professor of clinical medicine and the Mason Adams Professor of Geriatric Medicine at Weill Cornell Medical College, as well as an attending physician at New York-Presbyterian Hospital in New York, New York.
Consultant360: For your study, you and your team examined both high-risk and functional comorbidities in an ethnically diverse clinic population to compare the prevalence of comorbidities with different patterns of multimorbidity. What prompted this study objective?
Eugenia Siegler: This study resulted from the intersection of 2 phenomena at the Center for Special Studies (CSS), a longstanding program for PLWH in New York City. The first was the opportunity to take advantage of the breadth of information stored in the electronic health record to study a large, very diverse population of PLWH. The other was the privilege of working as a geriatrician with both patients and staff at CSS and learning about the wide variety of medical and social issues that occur as people age with HIV. Geriatricians are taught to think functionally, and I was struck by how often people had difficulty walking and doing daily tasks.
C360: Your study notes that age, longer time with an HIV diagnosis, and Black race was associated with high-risk comorbidities, while age, being a cisgender woman, Hispanic ethnicity, and longer time with an HIV diagnosis was associated with a higher number of functional comorbidities. Did these results surprise you?
ES: Certain associations, like age and length of time with an HIV diagnosis, did not surprise us. We were surprised by the ethnic differences between the types of comorbidities, and much more research must be done to explore these differences. There is growing literature showing that HIV affects women differently than men, and we hope that this study contributes to that literature.
C360: What clinical pearls would you give your colleagues relating to managing these comorbidities in this patient population?
ES: Many people have multiple comorbidities, also known as multimorbidity. It can be frustrating for a patient who is already taking multiple medications for their hypertension, diabetes, and hyperlipidemia to hear that you want to investigate whether they have other comorbidities. But taking a functional approach helps—asking, for example, if they are having difficulty hearing, seeing, climbing stairs, maintaining their balance, dealing with pain, or concentrating. It enables you to address the comorbidities that underlie these impairments. It also encourages the patient to talk about aging concerns.
C360: Could you discuss some expected challenges that may arise when treating aging patients with HIV?
ES: Multimorbidity often leads to polypharmacy, and reducing medication burden is often very difficult. Reviewing the medication list and asking which medications can be discontinued is essential.
People aging with HIV who are in their 50s or 60s may also be caring for parents, and caregiver burden can be significant. They may also be worried about their own cognition, especially as if they are caring for a loved one who is cognitively impaired.
Finding the time as a clinician to ask the patient how he or she feels about aging is challenging, but in my experience, it is a worthwhile investment, even for PLWH who are in their 50s or 60s.
C360: What other knowledge gaps exist about both high-risk and functional comorbidities in PLWH?
ES: It is important to underscore that our division of comorbidities into high risk and functional comorbidities was based on our best guesses. There is rich literature describing the more commonly investigated comorbidities like hypertension, diabetes, and coronary artery disease. I would love to see investigations of the burden of comorbidities such as arthritis, neuropathies, and sensory impairments in older PLWH. Another area that is starting to grow but remains understudied is how the longstanding infection with HIV affects prevalence and impact of comorbidities in adults who were congenitally infected with HIV. They are long-term survivors, too.
Reference:
Siegler E, Moxley J, Mauer E, Glesby M. Cross-sectional study of correlates and prevalence of functional and high-risk multimorbidity in an academic HIV practice in New York City. BMJ Open. Published online August 11, 2021. doi:10.1136/bmjopen-2020-047199