Comorbidity and Treatment Burden Among HIV-Infected Patients in a US Medicaid Population

Abstract

Objectives: To describe the contemporary comorbidity profile and treatment burden among patients with HIV-1 infection. MethOds: A retrospective study utilizing Medicaid claims data from 4 states was conducted. Patients with ≥ 1 antiretroviral (ARV) claim in 2016-2017 (most recent claim defined the index date), ≥ 1 HIV diagnosis within one year prior to index, age ≥ 18 years at first HIV diagnosis and < 65 at index, ≥ 12 months of continuous eligibility prior to index, and no history of HIV-2 were included. Comorbidities, concomitant medication use, and pill burden were assessed in the years prior to index. Stratified analyses were conducted in patients < 50 and ≥ 50 years. Results: Among 3,456 study patients, the mean (standard deviation [SD]) age was 47.1 (10.4) years; the majority were Black (55.1%) and male (62.8%). In the year prior to index, mean (SD) daily pill burden was 2.1 (1.4) for ARVs and 5.9 (5.9) for non-ARVs. Patients ≥ 50 years had higher daily pill burden (2.3 [1.5] ARVs, 6.9 [6.5] non-ARVs) than patients < 50 years (2.0 [1.3] ARVs, 5.0 [5.2] non-ARVs). Older patients had higher rates of comorbidities compared to younger patients (cardiovascular disease [CVD] 51.6% vs. 30.7%, hypertension 46.6% vs. 28.5%, asthma/ chronic obstructive pulmonary disease [COPD] 22.8% vs. 14.7%) in the year prior to index. Among all patients, the prevalence of comorbidities generally increased over time: 27.9% of patients had CVD in the fourth year prior to index, which increased to 40.3% in the first year prior to index. Similar increases were seen for hypertension (24.3% to 36.8%), hyperlipidemia (11.5% to 16.8%) and asthma/COPD (12.7% to 18.4%). Concomitant medication use corresponding to these comorbidities slightly increased over time. cOnclusiOns: As patients with HIV live longer, their comorbidities and corresponding concomitant medications increase. Treatment guidelines suggest that streamlined ARV regimens may be considered as patient complexity evolves over time.