Sukumaran, Luxsena; (2024) Mapping multimorbidity in people living with HIV: morbidity patterns, trajectories, mechanisms and health outcomes. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The widespread use of antiretroviral therapy and the consequent improvements in the survival of people living with HIV have shifted research priorities to address the increased burden of age-related complications, particularly multimorbidity. Understanding the health needs and challenges associated with multimorbidity is crucial for optimising care and improving long-term health outcomes in this population. This thesis aims to use data from prospective observational cohort studies of people with HIV to investigate various aspects of multimorbidity, including patterns, trends, determinants (socioeconomic, psychological, behavioural and biological factors) and associations with health outcomes. Common patterns of co-occurring conditions were identified using data-reduction techniques in people living with HIV. Distinct patterns of CVDs, Sexually transmitted infections (STIs), Cancers, Metabolic, Mental/Joint and Neurological disorders were identified. Significant interactions between physical and mental health conditions, particularly within the Mental/Joint pattern, were observed. Studying temporal trends revealed that certain patterns (e.g. CVDs) were more stable than others (e.g. Metabolic) over a 3-5-year follow-up period. Modifiable and non-modifiable risk factors showed varying associations with morbidity patterns. For instance, higher body mass index was identified as a significant predictor of both CVDs and Metabolic burden. Specific combinations of biomarkers related to distinct biological processes were associated with certain morbidity patterns, underscoring the potential predictive value of specific biomarkers for measuring multimorbidity burden. Analysis of health outcomes underscored the significant impact of multimorbidity on person-centred health outcomes, including quality of life, healthcare utilisation and cognitive function, in people with HIV. In particular, the Mental/Joint and Neurological patterns were found to impose the greatest burden across a wide range of health outcomes. In conclusion, the findings presented in this thesis provide new insights into the different aspects of multimorbidity in people living with HIV, offering valuable guidance for developing effective clinical guidelines, optimising resource allocation and designing tailored interventions to address the complex health needs of this population.

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