Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering.
Multimorbidity patterns in HIV-infected patients: the role of obesity in chronic disease clustering.
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DOI：
10.1097/qai.0b013e31827303d5
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发表时间：
2012-12-15
期刊：
影响因子：
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通讯作者：
Willig JH
中科院分区：
文献类型：
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作者：
Kim DJ;Westfall AO;Chamot E;Willig AL;Mugavero MJ;Ritchie C;Burkholder GA;Crane HM;Raper JL;Saag MS;Willig JH
在目前的治疗时代，在艾滋病毒感染人群中注意到多发性硬化症和肥胖症的增加。在这一人群中，多发病聚集的模式以及肥胖对多发病的影响尚未得到充分研究。我们研究了UAB 1917诊所的1844名HIV感染者的肥胖和多发病模式。探索性因素分析（EFA）被用来确定潜在的因素结构负责聚类。探讨了按体重指数（BMI）分类的发病因素模式。多变量logistic回归模型拟合，以确定多发病集群模式的预测因子。多发性骨髓瘤的患病率为65%（1205/1844）。患病率随着BMI从体重不足（64%）到肥胖（79%）的进展而增加。确定了三个多发病簇：“代谢”，包括高血压（HTN）、痛风、糖尿病和慢性肾脏疾病（CKD）（范围：0.41至0.84; P<0.001）;“行为”包括情绪障碍、血脂异常、慢性阻塞性肺病（COPD）、慢性溃疡病、骨关节炎、阻塞性睡眠呼吸暂停（OSA）和心脏疾病“物质滥用”包括酒精滥用、物质滥用、烟草滥用和丙型肝炎（范围：0.53 - 0.89; P<0.001）。肥胖与多发性硬化的几率增加相关（肥胖与正常BMI类别：OR=1.52，95%CI=1.15-2.00）。确定了三种疾病聚集模式。肥胖与多发性硬化的可能性较高有关。在未来的临床实践指南中，需要解决多发病和肥胖的管理问题，以提高艾滋病毒感染患者在当前治疗时代的长期结局。
Increases in multimorbidity and obesity have been noted in HIV infected populations in the current treatment era. Patterns of multimorbid disease clustering as well as the impact of obesity on multimorbidity are understudied in this population. We examined obesity and multimorbidity patterns among 1844 HIV-infected patients in the UAB 1917 Clinic. Exploratory factor analysis (EFA) was used to identify the underlying factor structure responsible for clustering. Patterns among the resulting morbidity factors by body mass index (BMI) category were explored. Multivariable logistic regression models were fit to identify predictors of multimorbidity cluster patterns. The prevalence of multimorbidity was 65% (1205/1844). Prevalence increased with progressive BMI categories from underweight (64%) to obese (79%). Three multimorbidity clusters were identified: “Metabolic” including hypertension (HTN), gout, diabetes mellitus, and chronic kidney disease (CKD) (range: 0.41 to 0.84; P<0.001); “Behavioral“ including mood disorders, dyslipidemia, chronic obstructive pulmonary disease (COPD), chronic ulcer disease, osteoarthritis, obstructive sleep apnea (OSA), and cardiac disorders (range: 0.32 to 0.57; P<0.001); “Substance Use” including alcohol abuse, substance abuse, tobacco abuse, and hepatitis C (range: 0.53 to 0.89; P<0.001). Obesity was associated with increased odds of multimorbidity (Obese vs. Normal BMI category: OR=1.52, 95%CI=1.15-2.00). Three patterns of disease clustering were identified. Obesity was associated with a higher likelihood of multimorbidity. The management of multimorbidity and obesity will need to be addressed in future clinical practice guidelines to enhance long term outcomes of HIV-infected patients in the current treatment era.