Comorbidity and polypharmacy among people with HIV stratified by age, sex, and race

Abstract

Background: With an increase in life expectancy of people with HIV, there is a corresponding rise in comorbidities and consequent increases in comedications. Objective: This study compared comorbidity and polypharmacy among people with HIV and people without HIV stratified by age, sex, and race. Methods: This retrospective study utilised administrative claims data to identify adult people with HIV with antiretroviral therapy (ART) claims and HIV diagnosis codes from 01 January 2018 to 31 December 2018. Index date was the earliest ART claim or HIV diagnosis in the absence of ART claims. Inclusion required continuous enrolment for ≥12-month pre-index and ≥30-day post-index, along with ≥1 HIV diagnosis during baseline or follow-up. People with HIV were matched 1:2 with people without HIV on sociodemographic. Results were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao-Scott tests. Results: Study sample comprised 20,256 people with HIV and 40,512 people without HIV. Mean age was 52.3 years, 80.0% males, 45.9% Caucasian, and 28.5% African American. Comorbidities were significantly higher in younger age people with HIV than people without HIV. Female had higher comorbidity across all comorbidities especially younger age people with HIV. Polypharmacy was also significantly greater for people with HIV versus people without HIV across all age categories, and higher in females. Across races, multimorbidity and polypharmacy were significantly greater for people with HIV versus people without HIV. Conclusions: Comorbidities and polypharmacy may increase the risk for adverse drug-drug interactions and individualised HIV management for people with HIV across all demographics is warranted.

Keywords:

• HIV
• people with HIV
• comorbidity
• ART
• polypharmacy

Acknowledgements

Writing, editorial support, and formatting assistance was provided by Caroline Jennermann, MS, Bernard Tulsi, MS, and Gayle L. Allenback all employees of Optum, which was contracted and compensated by Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA for these services.

Consent form

This study used de-identified data in a manner compliant with the HIPAA. Institutional Review Board review and approval was neither required, nor sought.

Author contributions

All named authors meet the International Committee of Medical Journal Editors (ICMJE) 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., and J.M. 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., and E.K.B. were involved in the data analysis. B.K.T. was involved in result review and interpretation, manuscript writing, and critical review of the manuscript.

Disclosure statement

G.P. and B.K.T. are employees of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA (MSD). S.G. was working under an internship with MSD in partnership with The University of Mississippi, MS, USA. M.P., E.K.B., and K.M. were employed with Optum Inc., which was paid to conduct the study under contract with MSD. M.P. is now employed by the Henry M. Jackson Foundation, Bethesda, MD, USA. P.K. reports grant/research support from GSK, MSD, and Gilead; stock ownership with Merck & Co., Inc., Rahway, NJ, USA, Pfizer, Johnson & Johnson, GSK, and Gilead; and service as consultant/advisory board member with AMGEN, GSK, MSD, and Gilead.

Data availability statement

Data used in this study cannot be publicly disclosed. Proprietary data in the Optum Research Database cannot be accessed without data security and privacy protocols in place, and a restrictive licence agreement to ensure oversight.

Additional information

Funding

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