Background: People with HIV (PWH) experience a high prevalence of chronic pain (CP), substance use (SU), and cognitive impairment (CI). Existing HIV literature has not explored the multimorbidity of these conditions, nor their associations with broader wellbeing for PWH. We sought to understand the associations of multimorbidity with other chronic and HIV-related health correlates.

Methods: We analyzed cross-sectional electronic medical record data from 12,499 PWH in the DC Cohort. Logistic regression was conducted to assess the relative odds of experiencing several chronic conditions (liver cirrhosis, hepatitis C, chronic kidney disease, hypertension, dyslipidemia, diabetes) and key HIV-related clinical factors based on comorbidity group. Groups included individuals with CP, SU, or CI (non-mutually exclusive) and combinations of these conditions (e.g., CP and SU). Each group was compared to participants without any record of CP, SU, or CI respectively, adjusting for age, sex, race/ethnicity, housing status, and primary care clinic and covarying mental health.

Results: All groups were significantly associated with adjusted odds of several other chronic health conditions. CP and CI were most strongly associated with liver cirrhosis (aOR = 2.43, 95% CI: 1.86–3.17; aOR = 2.36, 95% CI: 1.81–3.07, respectively) and SU showed the strongest association with hepatitis C (aOR = 4.02, 95% CI: 3.20–5.04). Adjusted odds increased in the presence of more comorbidities; the full multimorbidity group demonstrated the highest odds of liver cirrhosis (aOR = 5.96, 95% CI: 3.33–10.68) and hepatitis C (aOR = 6.92, 95% CI: 3.96–12.10), as well as AIDS diagnosis (aOR = 2.30, 95% CI: 1.81–2.93). CP was also linked to higher viral loads (≥200 copies/mL, aOR = 1.41, 95% CI: 1.29–1.53), while SU was associated with lower odds of having a viral load ≥200 copies/mL (aOR = 0.68, 95% CI: 0.62–0.74).

Conclusions: Our findings highlight the burden of CP, SU, and CI among PWH. All conditions and groups were independently associated with other comorbidities, with an especially strong burden observed for the full multimorbidity group. Continuing to explore experiences of multimorbidity will be important for supporting the complete health and quality of life of PWH.