Increasing multimorbidity burden after COVID-19 Infection Among People with and without HIV in the United States: Insights from the National Clinical Cohort Collaborative (N3C)

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ID: 329171
2026
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Abstract
Abstract Background People with HIV (PWH) have a disproportionately high burden of chronic comorbidities. However, how their multimorbidity patterns differ from those of the general population and how COVID-19 infection may affect this burden have not been well characterized. Methods We conducted a retrospective cohort study using the National COVID Cohort Collaborative (N3C), including adults aged ≥18 years with a confirmed COVID-19 diagnosis between January 1, 2018, and December 31, 2024. Fourteen chronic comorbidities were identified using N3C concept sets. Exploratory factor analysis was used to identify multimorbidity patterns before and after COVID-19 diagnosis. Results Among 7,500,765 patients with COVID-19, 52,015 (0.7%) were PWH. The median age was 48 years (IQR, 33–63) and 57.3% were female. PWH consistently had a higher multimorbidity burden than PWoH, and this disparity widened after COVID-19: the proportion with ≥ 3 comorbidities rose from 45.0% to 55.9% among PWH versus 22.2% to 29.7% among PWoH. Four multimorbidity factors were identified in both periods: transplant and multiorgan disease; cardiometabolic disorder; substance use, psychiatric disorder, and liver disease; and obesity. After COVID-19, the leading pattern among PWH shifted toward cardiometabolic disorder. Conclusions PWH experience a disproportionately high multimorbidity burden, with disparities further amplified after COVID-19 diagnosis and the leading pattern shifting toward cardiometabolic dominance. These findings highlight the need for integrated, multimorbidity-focused care for PWH.
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Authors Yumeng Wang, Ahmed Sabit, Jerrod Anzalone, Dongmei Li, Eric Hurwitz, Nada Fadul, Shixiong Wei, Amy L. Olex, Sandra E. Safo, Jessica Y. Islam, Todd T. Brown, Christopher G. Chute, Melissa Haendel, Cara D Varley, Zachary Butzin-Dozier, Marlene Camacho‐Rivera, Emmanuel Nazaire Essam Nkodo, Rena C. Patel, Jing Sun, Adam Wilcox, Adam M Lee, Alexis Graves, Alfred (Jerrod) Anzalone, Amin Manna, Amit Saha, Amy Olex, Andrea Zhou, Andrew E. Williams, Andrew M. Southerland, Andrew T. Girvin, Anita Walden, Anjali Sharathkumar, Benjamin Amor, Benjamin Bates, Brian Hendricks, Brijesh Patel, G Caleb Alexander, Carolyn T. Bramante, Cavin Ward-Caviness, Charisse Madlock-Brown, Christine Suver, Christopher Dillon, Chunlei Wu, Clare Schmitt, Cliff Takemoto, Dan Housman, Davera Gabriel, David Eichmann, Diego Mazzotti, Donald E Brown, Eilis Boudreau, Elaine Hill, Emily Carlson Marti, Emily Pfaff, Evan French, Farrukh M. Koraishy, Federico Mariona, Fred Prior, George Sokos, Greg Martin, Harold P. Lehmann, Spratt Heidi, Hemalkumar B. Mehta, J W Awori Hayanga, Jami Pincavitch, Jaylyn Clark, Jeremy Harper, Jin Ge, Joel Gagnier, Johanna Loomba, John B. Buse, Jomol Mathew, Joni L. Rutter, Julie A. McMurry, Justin Guinney, Justin Starren, Karen Crowley, Katie R. Bradwell, Kellie M Walters, Ken Wilkins, Kenneth Gersing, Kenrick Cato, Kimberly Murray, Kristin Kostka, Lavance Northington, Lee Pyles, Lesley Cottrell, Lili Portilla, Mariam Deacy, Mark M. Bissell, Marshall Clark, Mary Emmett, Matvey B. Palchuk, Meredith Adams, Meredith Temple-O'Connor, Michael G. Kurilla, Michele Morris
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag560
URL
https://doi.org/10.1093/ofid/ofag560
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