Retrospective analysis of comorbidities and treatment burden among patients with HIV infection in a US Medicaid population

Abstract

Objective: Comorbidities and comedications are important factors influencing optimal therapy because people are living longer with HIV infection. This study describes the long-term comorbidity profile and treatment burden among people with HIV-1 infection.

Methods: This retrospective study included Medicaid claims data from patients with ≥1 antiretroviral (ARV) claim between 2016 and 2017 (most recent claim defined the index date), ≥1 HIV diagnosis within 1 year before index, age ≥18 years at first HIV diagnosis and <65 years at index, ≥12 months of continuous eligibility before index, and no history of HIV-2 infection. Comorbidities, concomitant medication use, and pill burden were assessed in the 4 years before index. Analyses were stratified by patient age and treatment experience.

Results: Among 3456 patients, the mean (standard deviation [SD]) age was 47.1 (10.4) years; the majority were black (55%) and men (63%). In general, the prevalence of comorbidities increased from the fourth year to the first year before index and included cardiovascular disease (28–40%), hypertension (24–37%), hyperlipidemia (12–17%), and asthma/chronic obstructive pulmonary disease (13–19%). Concomitant medication use corresponding to these comorbidities slightly increased over time. In the year before index, mean (SD) daily pill burden was 2.1 (1.4) for ARVs and 5.9 (5.9) for non-ARVs. Older age and prior treatment experience were associated with higher rates of comorbidities and greater pill burden.

Conclusions: In people with HIV infection, comorbidities and concomitant medication use increased with age, supporting considerations for streamlined ARV regimens highlighted in treatment guidelines.

Keywords:

• Antiretroviral therapy
• HIV burden
• comorbidity
• concomitant medication
• pill burden

Transparency

Declaration of funding

Support for research and writing was funded by ViiV Healthcare. Analysis Group, Inc., received research funding from ViiV Healthcare for the conduct of the study.

Declaration of financial/other relationships

MDS, RHB, EG, MM, CS, and MSD are employees of Analysis Group, Inc. AO and JP are employees of ViiV Healthcare and own stock in GlaxoSmithKline. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Editorial assistance was provided under the direction of the authors by Jeffrey Stumpf and Sherri Damlo of MedThink SciCom and funded by ViiV Healthcare.

Data availability statement

Study documents can be requested for further research from www.clinicalstudydatarequest.com.