Characterizing multimorbidity and the risk for hospitalization among people living with HIV from the African Cohort Study

BACKGROUND: Multimorbidity presents significant challenges for people living with HIV (PLWH) in sub-Saharan Africa given the dual burden of communicable and noncommunicable diseases. We aimed to characterize multimorbidity and examine its association with hospitalization among PLWH. METHODS: The African Cohort Study (AFRICOS) prospectively enrolls participants aged ≥ 15 years with and without HIV at 12 sites in Kenya, Tanzania, Uganda, and Nigeria. Our analyses were restricted to PLWH and ≥ 18 years of age at enrollment between February 2013 and May 2024. Multimorbidity, defined as the presence of two or more chronic conditions in addition to HIV, was ascertained through International Classification of Diseases version 10 codes on medical history documentation at study enrollment. Hospitalization was ascertained through case reporting forms. Hierarchical clustering was used to describe multimorbidity, and logistic regression reporting adjusted odds ratios (aOR) and 95% confidence intervals (CI) was used to evaluate the association between multimorbidity and hospitalization. RESULTS: Of 3199 PLWH, 1863 (58.2%) were women, and the median age was 37.3 years (interquartile range: 29.2-45.5). Multimorbidity prevalence was 12.4%. Anemia (8.3%), head-related disorders (7.3%), and neuropathy (6.6%) were most common. Hierarchical clustering identified gastrointestinal (n = 80) and neuropathy (n = 212) first. The hospitalization rate was 4.32 hospitalizations per 100 person-years. Multimorbidity was associated with increased hospitalization (aOR = 1.44; 95% CI, 1.06, 1.96) after adjusting for age, sex, country, antiretroviral therapy (ART) regimen, and viral suppression. CONCLUSIONS: Multimorbidity was relatively uncommon at enrollment among PLWH in AFRICOS; however, distinct comorbidity patterns-such as gastrointestinal conditions and neuropathy-highlight the need for integrated, context-specific care. Multimorbidity was associated with a higher risk for hospitalization, while factors such as age, ART regimen, and viral suppression point to key intervention targets. These findings emphasize the importance of monitoring multimorbidity over time and adapting HIV care models to address the emerging chronic disease burden.