Multimorbidity and Burden of Disease

With effective antiretroviral therapy, HIV has become a chronic disease, and life expectancy among HIV-infected persons is approaching that of HIV-uninfected persons. Despite this success, epidemiologic evidence suggests that the burden of multiple aging-related diseases, including cardiovascular disease, liver disease, metabolic abnormalities, chronic kidney disease, cognitive dysfunction, and osteoporosis, is higher in HIV-infected persons compared to their HIV-uninfected peers. These comorbid diseases tend to cluster in a single person, leading to multimorbidity and polypharmacy. Emerging evidence suggests that multimorbidity among HIV-infected persons results in functional decline, reduced quality of life, and increased mortality. In this review, we examine the epidemiology, risk factors, etiologies, and potential consequences of multimorbidity in aging HIV-infected persons. With aggressive risk factor management for comorbidities and less toxic antiretroviral medications, the burden of multimorbidity in HIV-infected persons can be reduced.