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September 10, 2025Open Access

Regional inequalities in comorbidity patterns among aging HIV populations in China: tales of two cities with distinct HIV dynamics

Key Points

Comorbidity prevalence was notably high, affecting 62.72% of older PLWH across two cities.
Chongqing displayed a significantly higher comorbidity rate (79.13%) compared to Jiamusi (49.47%), indicating regional health disparities.
Advanced age and lower CD4 counts were associated with increased comorbidity risks among older PLWH.
Network analysis identified hypertension as a central node linking various metabolic and infectious disease clusters.

Abstract

Introduction: Globally, the population of people living with HIV (PLWH) aged ≥50 years is rapidly growing, and these older PLWH face significant age-related comorbidity burdens. This study examined regional variations in comorbidity patterns among older PLWH in China to inform tailored interventions. Methods: A cross-sectional survey was conducted among PLWH ≥50 years receiving antiretroviral therapy (ART) in Chongqing and Jiamusi between April and September 2023. Data on demographics, HIV-related factors and 16 predefined comorbidities were collected. We estimated prevalence of comorbidity, identified its correlates using multivariate logistic regression, and explored disease clusters via association rule mining (Apriori algorithm) and network analysis. Results: Among 515 individuals, 74.95% were males and the median age was 60 (IQR:55-67) years. The overall comorbidity prevalence was 62.72%, with significant differences between Chongqing and Jiamusi (79.13% vs. 49.47%, P<0.001). Common conditions were dyslipidemia (19.22%), hypertension (19.03%), syphilis (14.17%) and cardio-cerebrovascular disease (11.07%). Chongqing had more metabolic comorbidities such as dyslipidemia (39.13%), while Jiamusi had more hypertension (20.00%) and syphilis (18.60%). Participants with advanced age, lower latest CD4 count, and higher healthcare burden showed significantly increased risk of comorbidity ( P<0.05). Association rule mining identified frequent pairs including "hypertension + cardio-cerebrovascular diseases" and "diabetes + dyslipidemia". Network analysis highlighted hypertension as a central node linking metabolic (hypertension-dyslipidemia-diabetes) and infectious (eg. syphilis, hepatitis) clusters. Conclusion: Older PLWH in China have a high multimorbidity burden with distinct regional patterns. Chongqing's older PLWH show metabolic comorbid profiles, whereas Jiamusi's show cardio-cerebrovascular and sexually transmitted infection (STI) comorbidity patterns. Region-specific prevention like blood pressure control in northeast and metabolic risk reduction in the southwest as well as integrated care models is recommended to reduce multimorbidity risk and improve healthy aging in this population.

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