Prevalence and Patient Awareness of Medical Comorbidities in an Urban AIDS Clinic

Abstract

Mortality in HIV-positive persons is increasingly due to non-HIV-related medical comorbidities. There are limited data on the prevalence and patient awareness of these comorbid conditions. Two hundred subjects at an urban HIV clinic were interviewed in 2005 to assess their awareness of 15 non-HIV-related medical comorbidities, defined as medical problems that are neither AIDS-defining by standard definitions, nor a direct effect of immune deficiency. Medical charts were subsequently reviewed to establish prevalence and concordance between selfreport and chart documentation. Eighty-four percent of subjects self-reported at least 1 of 15 medical comorbidities and 92% had at least 1 condition chart-documented. The top 5 chart-documented conditions were hepatitis C (51.5%), pulmonary disease (28.5%), high blood pressure (27%), high cholesterol (24.5%), and obesity (22.5%). In multivariate analysis, higher number of non-HIV-related medical comorbidities was associated with older age, female gender, and intravenous drug use as route of HIV transmission. Across self-reported non-HIV-related medical comorbidities, the absolute concordance rate ranged from 67% to 96%, the sensitivity ranged from 0% to 79%; the positive predictive value ranged from 0% to 100%. While the vast majority of largely urban minority HIVpositive subjects were diagnosed with non-HIV-related medical comorbidities, there is significant room for improvement in patient awareness. In order to help patients optimally access and adhere to medication and medical care for these non-HIV-related medical comorbidities, interventions and educational campaigns to improve patient awareness that take cultural background, literacy, and educational level into account should be developed, implemented, and evaluated.

The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough

“…psychosocial factors modulating CVD risk, or unsafe sexual behaviour and intravenous drug use affecting hepatitis risk. 9,[15][16][17][18] Furthermore, comorbidities may be related to the presence of the HIV infection itself, although it is thought that for some conditions, independent risk factors play a greater role than those that are HIV-related. 16 Diabetes and CVD may be related to antiretroviral toxicity.…”

“…15,28 The prevalence of comorbidity, particularly polypathology, in older patients confirms the need to treat HIV similarly to other chronic diseases: for example, considering routine monitoring in primary care in partnership with secondary care and exploring the use of a range of services including nursing, preventive and rehabilitation services, as well as home health and nursing homes. 29,30 There is also a clear need to tailor care provision for people with HIV to reduce mortality and morbidity risks by preventing comorbidities; through encouragement of lifestyle changes, screening, 29 education about comorbidity risks 15 and widening knowledge about self-management in those with multiple long-term conditions. 31 Practitioners need to be more aware of the risk of comorbidities in people with HIV, in particular depression, 32 hepatitis and tuberculosis, 33 and the safety implications of interactions between HIV and other medications.…”

Systemic Arterial Hypertension in people living with HIV/AIDS: integrative review

“…Regarding the evidence levels, the following distribution was observed: four on level IV (10,16,20,23) ; three on level V (21)(22)24) ; and ten on level VI (11)(12)(13)(14)(15)(16)(17)(18)(19)(25)(26) .…”

“…The characterization of the 17 articles showed the year of publication varied between 2001 and 2016, with six articles published in Brazil (10)(11)(12)(13)(14)(15) , five in the United States (16)(17)(18)(19)(20) , four in European countries (21)(22)(23)(24) , one article in Cameroon (25) and one in Chile (26) . Regarding the evidence levels, the following distribution was observed: four on level IV (10,16,20,23) ; three on level V (21)(22)24) ; and ten on level VI (11)(12)(13)(14)(15)(16)(17)(18)(19)(25)(26) .…”

“…Prevalence and patient awareness of medical comorbidities in an urban AIDS clinic (18) United States 2010…”