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.

Comorbidities and factors associated with health-related quality of life among people living with HIV/AIDS in Gandaki Province of Nepal

“…PLHIV are at risk of developing chronic complications and comorbidities, such as non-communicable diseases and mental health disorders too. Co-morbidities among HIV patients are high as a person can have variable extent of immune suppression, often accentuated when access to health services are compromised, and when a PLHIV has poor adherence to anti-retrovirals [36][37][38]. Across the globe, different co-morbidities are prevalent among HIV patients.…”

Redefining HIV care: a path toward sustainability post-UNAIDS 95-95-95 targets

“…Depending on the country's context some steps can happen before others or can be skipped altogether. Integration of services is essential because the increasing life expectancy ( 11 ) and the side effects of ART are leading to more co-morbidities among PLHIV ( 12 ). There is also a higher prevalence of mental health disorders among PLHIV than the general population ( 13 ).…”

Stigma and mental health among people living with HIV across the COVID-19 pandemic: a cross-sectional study

“…Mental health is extremely relevant when referring to people living with a chronic infection, such as HIV/ AIDS, even if it is not always investigated during routine follow-up visits, especially in HIV services in Low-Middle Income Countries (LMICs) [2]. While the availability of increasingly effective antiretroviral therapies (ART) has allowed for a significant reduction in disease mortality and for major increase in life expectancy of people living with HIV (PLWH) -which is now comparable to the one reported for uninfected individuals [3,4] -it appears that PLWH taking ART are still suffering from a higher burden of comorbidities than the general population, with a long way to go [5].…”