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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.

References

Centers for Disease Control and Prevention. HIV: people aged 50 and over. https://www.cdc.gov/hiv/group/age/olderamericans/index.html. Accessed October 3, 2021

Deeks SG, Phillips AN. HIV infection, antiretroviral treatment, ageing, and non-AIDS related morbidity. BMJ 2009; 338:a3172. doi: 10.1136/bmj.a3172

Guaraldi G, Orlando G, Zona S, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis 2011; 53(11):1120-1126. doi: 10.1093/cid/cir627

Guaraldi G, Malagoli A, Calcagno A, et al. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65-74 years and more than 75 years. BMC Geriatr 2018; 18(1):99. doi: 10.1186/s12877-018-0789-0

Hemkens LG, Bucher HC. HIV infection and cardiovascular disease. Eur Heart J 2014; 35:1373-1381. doi: 10.1093/eurheartj/eht528

Islam FM, Wu J, Jansson J, Wilson DP. Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis. BMC Public Health 2012; 12:234. doi: 10.1186/1471-2458-12-234

Kumar P, Paudel M, Prajapati G, et al. Increasing trends in multimorbidity and polypharmacy over a 5-year period in people living with HIV in the United States. Abstract presented at: IDWeek 2021; September 29, 2021. Abstract 71.

Quan H, Li B, Couris CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 2011; 173(6):676-682. doi: 10.1093/aje/kwq433

Triant VA, Brown TT, Lee H, Grinspoon SK. Fracture prevalence among human immunodeficiency virus (HIV)-infected versus non-HIV-infected patients in a large US healthcare system. J Clin Endocrinol Metab 2008; 93(9):3499-3504. doi: 10.1210/jc.2008-0828

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