Longer Life for People Living with HIV Increases Rates of Multimorbidity and Polypharmacy
Presenter: Princy Kumar, MD, Georgetown University Medical Center, Washington, DC.
A summary of Increasing Trends in Multimorbidity and Polypharmacy Over a 5-Year Period in People Living with HIV in the United States, September 30, 2021
According to Princy N. Kumar, MD, Chief Division of Infectious Diseases at Georgetown University Hospital, Washington, DC, “Advances in antiretroviral therapies (ART) have resulted in longer life for people living with HIV (PLWH) with an increased risk of age-related comorbidities and polypharmacy. Comorbidities include chronic kidney disease, cardiovascular disease, and fractures/osteoporosis with prescribed medications for comorbid conditions increasing the complexity and burden of treatment.”
Kumar described the conducted research, “In the retrospective analysis of commercial and Medicare Advantage enrollees from the Optum Research Database, annual cohorts of PLWH were constructed for each calendar year from 2014 to 2018 and included adults 18 years and older with 1 or more pharmacy claims for ART or medical claims with an HIV/AIDS diagnosis code (index date was the earliest claim date in each calendar year).”
In 2014, 2015, 2016, 2017, 2018, researchers identified 14,222, 14,527, 16,310, 18,571, 20,249 PLWH, respectively. “Notable statistically significant trends (all P < .001) were observed in demographics of PLWH across the years, including increases in mean age (48.9 to 52.4 years), proportion of females compared with males (17.2% to 20.3%), and Black race (25.9% to 29%),” said Kumar.
Over the 5 years, multimorbidity (2 or more non-HIV conditions) prevalence increased from 25.8% to 37.2%, and polypharmacy (5 or more non-ART medications) prevalence increased from 70.4% to 76.3%. Hypertension, hyperlipidemia, and neuropsychiatric conditions were the most prevalent comorbid conditions, with statistically significant upward trends in prevalence across the years. An increasing trend was also seen in Type 2 diabetes mellitus, chronic kidney disease, obesity/overweight, gastrointestinal disease, substance abuse, and cardiovascular disease.
For non-ART conditions, increases were observed in cardiovascular medications, antidepressant/antianxiety medications, anti-diabetic medications, steroids, proton pump inhibitors, and respiratory medications.
Kumar concluded, “Among aging PLWH, the prevalence of multimorbidity and polypharmacy has increased over recent years. The burden is especially high with cardiovascular and neuropsychiatric conditions. Identification and management of comorbidities that may increase the risk of complications are important. Clinicians need to consider the comorbidity profile in HIV management, including selection of appropriate ART to improve patient health by avoiding drug-disease and drug-drug interactions.”
Disclosures
Princy N. Kumar, MD: Amgen (Consultant/Advisory Board), Eli Lilly (Grants/Research Support), Gilead (Consultant/Advisory Board, Grants/Research Support, Stock Shareholder), GSK (Consultant/Advisory Board, Grants/Research Support, Stock Shareholder), Merck & Co, Inc (Consultant/Advisory Board, Grants/Research Support, Stock Shareholder, Honoraria), Pfizer (Stock Shareholder), Johnson & Johnson (Stock Shareholder). This research was sponsored by Merck Sharp & Dohme Corporation, a subsidiary of Merck & Company, Inc. Kenilworth, NJ.
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