Higher comorbidity and comedication burden in women and young people living with HIV

BACKGROUND: Advancements in antiretroviral therapies (ART) have led to longer life expectancies for people living with HIV (PLWH). An understanding of comorbidity and comedication prevalence in HIV subpopulations is important for personalized care.
METHODS: A retrospective study was conducted using an administrative claims database. Adults ('¥18 years) with '¥1 pharmacy claim for an ART or HIV/AIDS diagnosis code in medical claims during 2018 (index date: earliest ART/HIV claim) were identified (PLWH). Adults without HIV (PLWoH) were matched 2:1 with PLWH on age, gender, race, region, and insurance type. Continuous health plan enrollment of 12 months prior to (baseline), and 30 days after index date was required. Differences in baseline comorbidities and comedications between PLWH and PLWoH across age, gender and race were assessed using descriptive statistics.
RESULTS: At total of 20,256 PLWH were matched to 40,512 PLWoH. The mean age was 52 years, 20% were women and 28% were Black. Multimorbidity ('¥2 comorbidities) and polypharmacy ('¥5 non-ART drugs) prevalence was higher in PLWH than PLWoH, and increased with age, in women, and in Black populations, with the largest differences in prevalence observed in the 18-39 age group (Table 1). The prevalence of most comorbidities was higher in PLWH vs PLWoH in 18-39 age group, but differences varied in older groups. Comorbidities such as hypertension, cardiovascular disease (CVD), diabetes mellitus, and chronic kidney disease (CKD) were more prevalent in women than men among PLWH, but differences between PLWH vs PLWoH by gender were inconsistent (Table 1). Neuropsychiatric conditions were more prevalent in PLWH than PLWoH in all strata (p<0.05).

	PLWH							PLWoH
	18-39	40-49	50-59	60-69	70+	Women	Men	18-39	40-49	50-59	60-69	70+	Women	Men
Multimorbidity	24.1	38.9	53.0	69.0	80.0	59.4	48.5	11.1	28.6	46.7	60.2	75.4	52.9	39.3
CVD	3.2	5.5	11.4	19.5	32.9	14.3	12.0	1.2	4.6	10.9	19.2	32.0	12.6	11.3
Hypertension	8.2	20.5	35.3	52.0	68.3	44.6	31.2	4.5	18.0	35.2	50.0	66.7	38.8	30.5
Diabetes mellitus	2.3	7.6	13.7	23.1	30.4	21.0	12.1	1.6	8.6	17.8	25.3	31.5	19.5	14.9
CKD	3.5	7.0	12.7	20.9	33.7	18.0	12.5	1.3	5.1	9.7	14.1	22.5	11.0	9.0
Neuropsychiatric	18.8	22.8	26.9	29.6	28.5	29.0	24.4	10.2	16.8	21.4	19.6	20.9	25.6	16.1
Polypharmacy	56.6	70.5	79.5	87.6	92.4	81.5	75.0	31.0	50.3	65.8	78.6	86.5	74.9	57.3
All values presented are percents; BOLD font indicates where p<0.05 for differences between PLWH and PLWoH; Ages in years

CONCLUSIONS: Comorbidity and polypharmacy burden were higher in PLWH than PLWoH with notable differences in specific comorbidities in younger age groups and women. An individualized approach to care including ART can minimize drug-drug interactions and adverse events and thereby improve patient outcomes.