Comorbidity and comedication burden among people living with HIV in the United States

Abstract

Objective

To describe the burden of comorbid conditions and comedications among people living with HIV (PLWH) vs. people living without HIV (PLWoH).

Methods

This was a case–control study conducted among insured patients using administrative claims data. Adult PLWH were identified by antiretroviral therapy (ART) claims or HIV/AIDS diagnosis codes from 1 January 2018 to 31 December 2018 (index date was set by the earliest claim). Continuous enrollment was required for ≥12 months pre-index (baseline) and ≥30 days post-index (follow-up). Patients were required to have ≥1 HIV diagnosis during baseline or follow-up. Those with only HIV prophylaxis were excluded. PLWoH were matched 2:1 to PLWH on demographic characteristics. Study outcomes were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao–Scott tests.

Results

The study included 20,256 PLWH and 40,512 matched PLWoH, mean age 52 years. PLWH vs. PLWoH had higher mean (SD) Charlson comorbidity index scores (0.93 [1.59] vs. 0.61 [1.28]; p < .001) and a greater proportion had ≥1 comorbidity (69.1% vs. 54.5%, p < .001). The most prevalent comorbidities included hypertension (33.9% vs. 32.2%; p < .001), hyperlipidemia (29.4% vs. 24.6%; p < .001), chronic kidney disease (13.6% vs. 9.4%, p < .001), depression (13.1% vs. 7.3%, p < .001) and substance abuse (12.8% vs. 7.1%, p < .001). Mean (SD) non-ART prescription fills were higher among PLWH vs. PLWoH (11.9 [10.1] vs. 9.2 [9.4]; p < .001).

Conclusions

Multimorbidity and polypharmacy were more prevalent among PLWH vs. matched PLWoH. Findings support the need to consider comorbidities and comedications when choosing ART and to minimize drug–drug interactions and adverse events to improve patient outcomes.

Keywords:

• HIV
• comorbidity
• polypharmacy
• comedication

Transparency

Declaration of funding

This work was funded by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA.

Declaration of financial/other relationships

G.P. has disclosed that he is an employee of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA (Merck). J.M. has disclosed that he was an employee of Merck during the conduct of the study. S.G. has disclosed that she was working under an internship with Merck in partnership with the University of Mississippi, University, MS, USA. M.P., E.K.B. and K.M. have disclosed that during the study they were employed with Optum Inc., which was paid to conduct the study under contract with Merck. M.P. has disclosed that she is now employed by the Henry M. Jackson Foundation, Bethesda, MD, USA. P.K. has disclosed that she has received grant/research support from GSK, Merck and Gilead; has stock ownership with Merck, Pfizer, Johnson & Johnson, GSK and Gilead; and serves or has served as consultant/advisory board member with Amgen, GSK, Merck and Gilead.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All named authors meet the International Committee of Medical Journal Editors criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, contributed to the writing and reviewing of the manuscript, and have given final approval of the version to be published. M.P., G.P., S.G., J.M. and P.K. were involved in the conception and design of the study and data interpretation. E.K.B. and K.M. were involved in the acquisition of data. M.P., G.P., E.K.B. and P.K. were involved in the data analysis.

Acknowledgements

Writing, editorial support and formatting assistance were provided by Caroline Jennermann MS and Yvette Edmonds PhD, both employees of Optum, which was contracted and compensated by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co. Inc., Kenilworth, NJ, USA.

Data availability statement

Data used to generate these results cannot be disclosed publicly. Proprietary data obtained from the Optum Research Database may be accessed only with strictest data security and privacy protocols, and oversight with a restrictive license agreement.

Results in part were presented at the 2021 Conference on Retroviruses and Opportunistic Infections Virtual Meeting, 6–10 February 2021; and ID Week 2021 Virtual Meeting, 29 September–3 October 2021.

Ethics statement

This study used fully de-identified data extracts in a manner compliant with the Health Insurance Portability and Accountability Act of 1996. Institutional review board approval was neither required nor sought.