Abstract
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 from the baseline assessment of the CHART cohort (Comparative HIV and Aging Research in Taizhou). Ten non-AIDS comorbidities were investigated. Multiple logistic regression was used to assess the correlates of multimorbidity, defined as the coexistence of ≥2 non-AIDS comorbidities. Multimorbidity patterns were identified through hierarchical cluster analysis. RESULTS: The prevalence of multimorbidity was higher in PWH than in people without HIV (74.6% vs 66.9%, P < .001). This difference was particularly pronounced in women in each age group from 18 through 59 years and among men in each age group from 18 through 49 years. A significant interaction between sex and HIV on multimorbidity was identified (P < .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 a 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.