Strong Impact of Smoking on Multimorbidity and Cardiovascular Risk Among Human Immunodeficiency Virus-Infected Individuals in Comparison With the General Population

Barbara Hasse, Philip E Tarr, Pedro Marques-Vidal, Gerard Waeber, Martin Preisig, Vincent Mooser, Fabio Valeri, Sima Djalali, Rauch Andri, Enos Bernasconi, Alexandra Calmy, Matthias Cavassini, Pietro Vernazza, Manuel Battegay, Rainer Weber, Oliver Senn, Peter Vollenweider, Bruno Ledergerber, V Aubert, J Barth, M Battegay, E Bernasconi, J Böni, H C Bucher, C Burton-Jeangros, A Calmy, M Cavassini, M Egger, L Elzi, J Fehr, J Fellay, H Furrer, C A Fux, M Gorgievski, H Günthard, D Haerry, B Hasse, H H Hirsch, I Hösli, C Kahlert, L Kaiser, O Keiser, T Klimkait, R Kouyos, H Kovari, B Ledergerber, G Martinetti, B Martinez de Tejada, K Metzner, N Müller, D Nadal, G Pantaleo, A Rauch, S Regenass, M Rickenbach, C Rudin, F Schöni-Affolter, P Schmid, D Schultze, J Schüpbach, R Speck, C Staehelin, P Tarr, A Telenti, A Trkola, P Vernazza, R Weber, S Yerly, Aubry Jean-Michel, Bochud Murielle, Gaspoz Jean Michel, Hock Christoph, Lüscher Thomas, Marques Vidal Pedro, Mooser Vincent, Paccaud Fred, Preisig Martin, Vollenweider Peter, Von Känel Roland, Vladeta Aidacic, Waeber Gerard, Beriger Jürg, Bertschi Markus, Bhend Heinz, Büchi Martin, Bürke Hans-Ulrich, Bugmann Ivo, Cadisch Reto, Charles Isabelle, Chmiel Corinne, Djalali Sima, Duner Peter, Erni Simone, Forster Andrea, Frei Markus, Frey Claudius, Frey Jakob, Gibreil Musa Ali, Günthard Matthias, Haller Denis, Hanselmann Marcel, Häuptli Walter, Heininger Simon, Huber Felix, Hufschmid Paul, Kaiser Eva, Kaplan Vladimir, Klaus Daniel, Koch Stephan, Köstner Beat, Kuster Benedict, Kuster Heidi, Ladan Vesna, Lauffer Giovanni, Leibundgut Hans Werner, Luchsinger Phillippe, Lüscher Severin, Maier Christoph, Martin Jürgen, Meli Damian, Messerli Werner, Morger Titus, Navarro Valentina, Rizzi Jakob, Rosemann Thomas, Sajdl Hana, Schindelek Frank, Schlatter Georg, Senn Oliver, Somaini Pietro, Staeger Jacques, Staehelin Alfred, Steinegger Alois, Steurer Claudia, Suter Othmar, Truong The Phuoc, Vecellio Marco, Violi Alessandro, Von Allmen René, Waeckerlin Hans, Weber Fritz, Weber-Schär Johanna, Widler Joseph, Zoller Marco

Background.  Although acquired immune deficiency syndrome-associated morbidity has diminished due to excellent viral control, multimorbidity may be increasing among human immunodeficiency virus (HIV)-infected persons compared with the general population. Methods.  We assessed the prevalence of comorbidities and multimorbidity in participants of the Swiss HIV Cohort Study (SHCS) compared with the population-based CoLaus study and the primary care-based FIRE (Family Medicine ICPC-Research using Electronic Medical Records) records. The incidence of the respective endpoints were assessed among SHCS and CoLaus participants. Poisson regression models were adjusted for age, sex, body mass index, and smoking. Results.  Overall, 74 291 participants contributed data to prevalence analyses (3230 HIV-infected; 71 061 controls). In CoLaus, FIRE, and SHCS, multimorbidity was present among 26%, 13%, and 27% of participants. Compared with nonsmoking individuals from CoLaus, the incidence of cardiovascular disease was elevated among smoking individuals but independent of HIV status (HIV-negative smoking: incidence rate ratio [IRR] = 1.7, 95% confidence interval [CI] = 1.2-2.5; HIV-positive smoking: IRR = 1.7, 95% CI = 1.1-2.6; HIV-positive nonsmoking: IRR = 0.79, 95% CI = 0.44-1.4). Compared with nonsmoking HIV-negative persons, multivariable Poisson regression identified associations of HIV infection with hypertension (nonsmoking: IRR = 1.9, 95% CI = 1.5-2.4; smoking: IRR = 2.0, 95% CI = 1.6-2.4), kidney (nonsmoking: IRR = 2.7, 95% CI = 1.9-3.8; smoking: IRR = 2.6, 95% CI = 1.9-3.6), and liver disease (nonsmoking: IRR = 1.8, 95% CI = 1.4-2.4; smoking: IRR = 1.7, 95% CI = 1.4-2.2). No evidence was found for an association of HIV-infection or smoking with diabetes mellitus. Conclusions.  Multimorbidity is more prevalent and incident in HIV-positive compared with HIV-negative individuals. Smoking, but not HIV status, has a strong impact on cardiovascular risk and multimorbidity.