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

BACKGROUND: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.