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IDWeek 2016: Comorbidities Are Common and Rising Among People with HIV

People living with HIV are increasingly experiencing a range of non-AIDS-related comorbidities as the population ages, including cardiovascular disease, kidney impairment, and bone loss leading to fractures, according to research presented at the recent IDWeek 2016 meeting in New Orleans.

Thanks to effective antiretroviral therapy (ART), more HIV-positive people in the U.S. and Europe are surviving to older ages. Estimates indicate that nearly half of people living with HIV in the U.S. are age 50 or older, and in San Francisco -- an early epicenter of the epidemic -- the proportion has reached 60%. While some research has found that HIV-positive people who were treated promptly with modern ART may have a life expectancy close to that of HIV-negative individuals, those who developed advanced immune deficiency or were treated with suboptimal therapy often have ongoing health problems.

Studies have shown that people with HIV are at higher risk for developing chronic non-AIDS conditions such as heart disease and cancer, and they may do so at younger ages. Some of these conditions have been linked to specific antiretroviral drugs, including kidney impairment and bone loss with tenofovir (Viread) and cardiovascular events with abacavir (Ziagen).

Xue Song from Truven Health Analytics and colleagues compared rates of comorbid conditions and trends over time among HIV-positive and HIV-negative people.

Using Truven Health MarketScan Databases, the researchers selected more than 37,000 adults diagnosed with HIV and treated with ART during 2003-2013. The databases included more than 41 million people with commercial health coverage and about 8 million Medicaid enrollees from multiple states. HIV-positive people were matched with up to 3 HIV-negative control subjects based on demographic variables, region, and type of health coverage.

The analysis included 21,180 HIV-positive people and 66,027 controls with commercial health coverage. Most (84%) were men, the mean age was approximately 48 years, and 12% were over age 50. In addition, there were 16,431 people with HIV and 45,556 controls on Medicaid. In this group only about half (53%) were men and the mean age was about 50 years.

Results

• People with HIV were found to have significantly higher comorbidity rates that HIV-negative people, and people on Medicaid generally had more health problems than those with commercial coverage.
• Cardiovascular disease:

o   Commercial cohort: 7% of HIV-positive vs 4% of HIV-negative;

o   Medicaid cohort: 11% vs 8%, respectively.

• Kidney disease:

o   Commercial cohort: 9% vs 3%;

o   Medicaid cohort: 15% vs 6%.

• Osteoporosis and fractures:

o   Commercial cohort: 8% vs 6%;

o   Medicaid cohort: 13% vs 10%.

• Other comorbidities were more common, but occurred with similar frequency among people with and without HIV.
• Hypertension:

o   Commercial cohort: 31% of HIV-positive vs 30% of HIV-negative;

o   Medicaid cohort: 37% vs 34%, respectively.

• Hyperlipidemia:

o   Commercial cohort: 31% vs 30%;

o   Medicaid cohort: 22% vs 24%.

• Endocrine disease:

o   Commercial cohort: 21% vs 18%;

o   Medicaid cohort: 26% vs 25%.

• People with HIV were much more likely than HIV-negative people to have hepatitis C, in the commercial cohort (5% vs 1%) and especially in the Medicaid cohort (23% vs 4%).
• Between 2003 and 2013, the media age of treated people with HIV rose in both the commercial (from 44 to 48 years) and Medicaid (from 42 to 48 years) cohorts.
• Among people with HIV in the commercial cohort, the proportion with comorbidities increased between 2003 and 2013 for diabetes (from 6% to 9%), hypertension (10% to 25%), hyperlipidemia (10% to 23%), obesity (1% to 5%), and endocrine disease (10% to 16%).
• Comorbidities increased even more over time in the HIV-positive Medicaid cohort: diabetes (from 9% to 17%), hypertension (16% to 47%), hyperlipidemia (8% to 29%), obesity (2% to 12%), and endocrine disease (14% to 24%).
• Rates of cardiovascular events, kidney impairment, and fractures rose from 2003 to 2013 in both the HIV-positive and HIV-negative groups with either commercial coverage or Medicaid, but the proportion with these 3 comorbidities was consistently higher among HIV-positive people.

"HIV patients have multiple non-AIDS-related comorbidities, including risk factors for renal impairment, cardiovascular disease, and fracture/osteoporosis," the researchers concluded. "Among treated HIV patients, the prevalence of comorbidities is increasing over time, especially renal, bone, and cardiovascular comorbidities."

Song noted that commercially insured individuals are typically the healthiest population in the U.S. with the best access to health care, so their data represents comorbidities among the best served patients with HIV.

Medicaid patients had higher rates of comorbidities than commercial patients despite similar ages. In addition, the Medicaid population had more turnover and had greater differences in comorbidity rates between HIV-positive and HIV-negative people.

As a limitation, the researchers noted that these findings may not be generalizable to people with other types of health care coverage or with no insurance.

12/15/16

Source

P Hsue, S Shreay, X Song, and N Meyer. A Longitudinal Analysis of Comorbidities among Human Immunodeficiency Virus (HIV) Patients and Matched non-HIV Controls in the USA. IDWeek. New Orleans, October 26-30, 2016. Abstract 950.