Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews

Abstract

Background

As the human immunodeficiency virus (HIV) treatment landscape continues to evolve, the prolonged life expectancy and long-term exposure to antiretroviral drugs have modified the burden associated with living with HIV.

Objective

To better understand the current treatment and comorbidity burden in people living with HIV (PLWH).

Methods

Peer-reviewed systematic literature reviews (SLRs) between 2017 and 2020 that included US studies and examined drug adherence/pill burden, resistance burden, or comorbidities in PLWH were identified. Methods and findings were extracted for the overall studies and examined in the subset of US studies.

Results

Among 665 publications identified, 47 met the inclusion criteria (drug adherence/pill burden: 5; resistance: 3; comorbidities: 40). While antiretroviral drug adherence levels varied across SLRs, single-tablet regimens (STR) were associated with higher adherence versus multiple-tablet regimens. STRs were also associated with lower risk of treatment discontinuation, higher cost-effectiveness, and lower risk of hospitalization. Longer survival resulted in a high comorbidity burden, with non-AIDS causes accounting for 47% of deaths among PLWH in the US. HIV doubled the risk of cardiovascular disease and was associated with other health problems, including bone and muscle diseases, depression, and cancers. Several antiretroviral regimens were associated with chronic diseases, including cardiometabolic conditions. Lifetime HIV costs are substantially increasing, driven by antiretroviral, adverse event, and comorbidity treatment costs cumulated due to longer survival times.

Conclusions

There is a considerable burden associated with HIV and antiretroviral treatment, highlighting the benefits of less complex and safer regimens, and the unmet need for effective preventative interventions.

Keywords:

• Adherence
• antiretrovirals
• comorbidities
• human immunodeficiency virus
• treatment resistance

Transparency

Declaration of funding

Financial support for this research was provided by Janssen Scientific Affairs, LLC (JSA). The study sponsor was involved in several aspects of the research, including the study design, the interpretation of data, the writing of the manuscript, and the decision to submit the manuscript for publication.

Declaration of financial/other relationships

BOT has served as a paid consultant to ViiV Healthcare, GSK, Gilead, Merck, and JSA. HR and MHL are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to JSA, which funded the development and conduct of this study and manuscript. RB and KM were employees of Analysis Group, Inc. at the time of study conduct.

PD is an employee of JSA and stockholder of Johnson & Johnson.

Author contributions

HR, MHL, RB, and KM contributed to study conception and design, literature search, and data analysis and interpretation. BOT and PD contributed to study conception and design, and data analysis and interpretation. All authors reviewed and approved the final content of this manuscript.

Acknowledgements

Medical writing support was provided by a professional medical writer, Christine Tam, an employee of Analysis Group, Inc.

Data availability statement

All data included in the study are publicly available or available for purchase through the journal or publisher.

Reviewer disclosures

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