Multimorbidity Trajectories and Hospitalization Risk Among People With Human Immunodeficiency Virus in Sub-Saharan Africa: A Longitudinal Analysis From the African Cohort Study.

Abstract

Increasing multimorbidity among people with human immunodeficiency virus (PWH; HIV) in sub-Saharan Africa can result in hospitalization. We investigated longitudinal associations between multimorbidity trajectories and hospitalization risk within the African Cohort Study (AFRICOS). AFRICOS enrolls people with and without HIV from HIV clinics in Uganda, Kenya, Tanzania, and Nigeria. These analyses restricted PWH aged ≥18 years enrolled between 2013 and 2024. Multimorbidity (≥chronic conditions in addition to HIV) was ascertained from International Classification of Diseases codes and clinical measurements. Multimorbidity was categorized into 3 trajectories: resilient, developed, and continued. Hospitalization reasons were ascertained by medical record review. Andersen-Gill extensions of Cox proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the association of multimorbidity trajectory and hospitalization. Among 3028 PWH, 36.6% (n = 1109) had multimorbidity at enrollment. Over 17 740 person-years, 721 hospitalizations occurred (incidence density: 4.06 per 100 person-years). Systemic infections (n = 209, 29.0%), predominantly malaria (n = 182, 87.1%), led admissions. In adjusted models, PWH with continued multimorbidity had a significantly higher risk of hospitalization (aHR = 1.27, 95% CI: 1.06-1.53) compared with resilient PWH. PWH with continued multimorbidity have a significantly increased risk of hospitalization. Intervening early with optimal ART and comprehensive chronic disease management is critical for improving long-term outcomes in sub-Saharan Africa.