Non-HIV Comorbid Conditions and Polypharmacy Among People Living with HIV Age 65 or Older Compared with HIV-Negative Individuals Age 65 or Older in the United States: A Retrospective Claims-Based Analysis

Kong, Amanda M.; Pozen, Alexis; Anastos, Kathryn; Kelvin, Elizabeth A.; Nash, Denis

doi:10.1089/apc.2018.0190

Cited by 73 publications

(64 citation statements)

References 63 publications

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“…Of interest, differences in the prevalence of polypharmacy between PLWH and age‐matched uninfected individuals were shown to be less pronounced in older age groups (i.e. 65 to 74 and ≥75 years) . This finding may be explained by the natural occurrence of age‐related chronic diseases regardless of HIV infection.…”

Section: Discussionmentioning

confidence: 98%

The challenge of HIV treatment in an era of polypharmacy

2020

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Introduction The availability of potent antiretroviral therapy has transformed HIV infection into a chronic disease such that people living with HIV (PLWH) have a near normal life expectancy. However, there are continuing challenges in managing HIV infection, particularly in older patients, who often experience age‐related comorbidities resulting in complex polypharmacy and an increased risk for drug‐drug interactions. Furthermore, age‐related physiological changes may affect the pharmacokinetics and pharmacodynamics of both antiretrovirals and comedications thereby predisposing elderly to adverse drug reactions. This review provides an overview of the therapeutic challenges when treating elderly PLWH (i.e. >65 years). Particular emphasis is placed on drug‐drug interactions and other common prescribing issues (i.e. inappropriate drug use, prescribing cascade, drug‐disease interaction) encountered in elderly PLWH. Discussion Prescribing issues are common in elderly PLWH due to the presence of age‐related comorbidities, organ dysfunction and physiological changes leading to a higher risk for drug‐drug interactions, drugs dosage errors and inappropriate drug use. Conclusions The high prevalence of prescribing issues in elderly PLWH highlights the need for ongoing education on prescribing principles and the optimal management of individual patients. The knowledge of adverse health outcomes associated with polypharmacy and inappropriate prescribing should ensure that there are interventions to prevent harm including medication reconciliation, medication review and medication prioritization according to the risks/benefits for each patient.

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Section: Discussionmentioning

confidence: 98%

The challenge of HIV treatment in an era of polypharmacy

2020

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“…lung and colorectal cancer), among other conditions, compared to those without an HIV diagnosis. Likewise, these patients are more likely to have multiple comorbidities and polypharmacy compared to older people without diagnosed HIV [11,12,18,[27][28][29][33][34][35][36][37][38][39][40][41][42] for a selection of examples].…”

Section: Introductionmentioning

confidence: 99%

Assessing the health status and mortality of older people over 65 with HIV

et al. 2020

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Background Nearly half of people with HIV in the United States are 50 years or older, and this proportion is growing. Between 2012 and 2016, the largest percent increase in the prevalence rate of HIV was among people aged 65 and older, the eligibility age for Medicare coverage for individuals without a disability or other qualifying condition. Previous work suggests that older people with HIV may have higher rates of chronic conditions and develop them more rapidly than older people who do not have HIV. This study compared the health status of older people with HIV with the older US population not living with HIV by comparing: (1) mortality; (2) prevalence of certain conditions, and (3) incidence of these conditions with increasing age. Methods and findings We used a sample of Medicare beneficiaries aged 65 and older from the Medicare Master Beneficiary Summary File for the years 2011 to 2016, including 100% of individuals with HIV (N = 43,708), as well as a random 1% sample of individuals without diagnosed HIV (N = 1,029,518). We conducted a survival analysis using a Cox proportional hazards model to assess mortality and to determine the need to adjust for differential mortality in our analyses of the incidence of certain chronic conditions. These results showed that Medicare beneficiaries living with HIV have a significantly higher hazard of mortality compared to older people without diagnosed HIV (3.6 times the hazard). We examined the prevalence of these conditions using logistic regression analysis and found that people with HIV have a statistically significant higher odds of depression, chronic kidney disease, chronic obstructive pulmonary disease (COPD), osteoporosis, hypertension, ischemic heart disease, diabetes, chronic hepatitis, end-stage liver disease, lung cancer, and colorectal cancer. To look at the rate at which older people are diagnosed with conditions as they age, we used a Fine-Gray competing risk model and showed that for individuals without diagnosis of a given condition at age 65, the future incidence of that condition over the remaining study period was higher for people with HIV even after adjusting for differential hazard of mortality and for other demographic characteristics. Many of these results also varied by personal characteristics including Medicaid dual enrollment, sex, and race and ethnicity, as well as by condition. Conclusions Increasing access to care and improving health outcomes for people with HIV is a critical goal of the National HIV/AIDS Strategy 2020. It is important for clinicians and policymakers to be aware that despite significant advances in the treatment and care of people with HIV, older people with HIV have a higher odds of having multiple chronic conditions at any point in time, a higher incidence of new diagnoses of these conditions over time, and a higher hazard of mortality than Medicare beneficiaries without HIV.

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“…This observation agrees with reports from Norway and the USA suggesting that the prevalence of hypertension was not significantly different 46 or higher among HIV-negative individuals compared with PLWH. 18 Conversely, we observed apparent overlaps in the prevalence trends of non-AIDS-defining cancers, diabetes and osteoarthritis particularly in the early years of the study, followed by a steeper increase in the prevalence of these conditions among PLWH. Given the late onsets of both non-AIDS-defining cancers 47 and osteoarthritis, 48 these trends may likely be explained by the disproportionate presence of competing risks of death among PLWH in the earlier years of the study.…”

Section: Discussionmentioning

confidence: 63%

“… 17–21 In addition, some studies also used more lenient case-finding algorithms (eg, identifying comorbidity diagnoses from a single physician visit), thus not addressing the nature of administrative data, and its susceptibility to coding errors. 18 21 …”

Section: Introductionmentioning

confidence: 99%

Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

et al. 2021

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ObjectivesAs people living with HIV (PLWH) live longer, morbidity and mortality from non-AIDS comorbidities have emerged as major concerns. Our objective was to compare prevalence trends and age at diagnosis of nine chronic age-associated comorbidities between individuals living with and without HIV.Design and settingThis population-based cohort study used longitudinal cohort data from all diagnosed antiretroviral-treated PLWH and 1:4 age-sex-matched HIV-negative individuals in British Columbia, Canada.ParticipantsThe study included 8031 antiretroviral-treated PLWH and 32 124 HIV-negative controls (median age 40 years, 82% men). Eligible participants were ≥19 years old and followed for ≥1 year during 2000 to 2012.Primary and secondary outcome measuresThe presence of non-AIDS-defining cancers, diabetes, osteoarthritis, hypertension, Alzheimer’s and/or non-HIV-related dementia, cardiovascular, kidney, liver and lung diseases were identified from provincial administrative databases. Beta regression assessed annual age-sex-standardised prevalence trends and Kruskal-Wallis tests compared the age at diagnosis of comorbidities stratified by rate of healthcare encounters.ResultsAcross study period, the prevalence of all chronic age-associated comorbidities, except hypertension, were higher among PLWH compared with their community-based HIV-negative counterparts; as much as 10 times higher for liver diseases (25.3% vs 2.1%, p value<0.0001). On stratification by healthcare encounter rates, PLWH experienced most chronic age-associated significantly earlier than HIV-negative controls, as early as 21 years earlier for Alzheimer’s and/or dementia.ConclusionsPLWH experienced higher prevalence and earlier age at diagnosis of non-AIDS comorbidities than their HIV-negative controls. These results stress the need for optimised screening for comorbidities at earlier ages among PLWH, and a comprehensive HIV care model that integrates prevention and treatment of chronic age-associated conditions. Additionally, the robust methodology developed in this study, which addresses concerns on the use of administrative health data to measure prevalence and incidence, is reproducible to other settings.

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Non-HIV Comorbid Conditions and Polypharmacy Among People Living with HIV Age 65 or Older Compared with HIV-Negative Individuals Age 65 or Older in the United States: A Retrospective Claims-Based Analysis

Cited by 73 publications

References 63 publications

The challenge of HIV treatment in an era of polypharmacy

The challenge of HIV treatment in an era of polypharmacy

Assessing the health status and mortality of older people over 65 with HIV

Excess burden of age-associated comorbidities among people living with HIV in British Columbia, Canada: a population-based cohort study

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