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Comorbidity Rate, Non-ARV Prescriptions Higher
in HIV-Positives Than Matched Controls
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Mark Mascolini
Compared with HIV-negative people in an insurance claims database, age- and gender-matched HIV-positive people were more likely to have one or more comorbidities, had prescriptions for significantly more drug classes and nonantiretroviral (non-ARV) drugs, and were more likely to be taking more than 5 non-ARV drugs [1].
About three quarters of HIV-positive people in the United States are 40 or older [2], and the proportion older than 50 continues to grow. Regardless of HIV status, older age means more comorbidities, but accumulating evidence indicates HIV-positive people endure more comorbidities than HIV-negative people the same age.
To get a better fix on comorbidities and medication burden in people with HIV and age-matched controls, researchers at GlaxoSmithKline, the University of North Carolina-Chapel Hill, and other institutions conducted this study based on a US healthcare claims databases (Clinformatics DataMart Multiplan). The HIV group consisted of outpatients with full pharmacy benefits, an HIV diagnosis before the observation period began, and database enrollment of at least 12 months. The researchers divided HIV-positive people into two groups, those 18 to 49 and those 50 and older. Each group was matched 1-to-3 to HIV-negative people the same age and gender. The study period ran from April 1, 2009 to March 31, 2010.
The analysis included (1) 7529 HIV-positive people 50 and older and 22,587 HIV-negative controls and (2) 15,811 HIV-positive people 18 to 49 years old and 47,433 HIV-negative controls. In the older group, 21% were women, and in the younger group 28% were women. In the younger HIV-positive group, 13% were 18 to 29, 32% were 30 to 39, and 55% were 40 to 49. Most of the older HIV group (85%) and the younger HIV group (89%) had a viral load below 500 copies.
Among people 50 and older, those with HIV had prescriptions for an average 6.9 drug classes and those without HIV for 4.6 classes over the 12-month study period (P < 0.0001). Just over half of the older HIV-positive group (53.6%) got prescriptions for 5 or more non-ARVs, compared with 34.3% of the HIV-negative group. Among people 18 to 49, the HIV-positive group had prescriptions for an average 4.8 drug classes, compared with 2.9 in the matched HIV-negative group (P < 0.0001). More than one third of the 18-to-49 HIV-positive group took 5 or more non-ARVs, compared with fewer than one fifth of controls (35.4% versus 18.8%).
As one would expect, number of comorbidities correlated positively with number of drugs prescribed. In the HIV-positive 50-and-older group, proportions prescribed more than 5 non-ARVs were 22.3% for those with no reported comorbidities, 57% for those with 2 or 3 comorbidities, and 89.8% for those with more than 5 comorbidities. Among HIV-positive people 18 to 49 years old, proportions prescribed more than 5 non-ARVs were 18.5% for those with no reported comorbidities, 49.7% for those with 2 or 3 comorbidities, and 82.1% for those with more than 5 comorbidities. The same positive correlations held true for the comparison groups without HIV.
Both HIV-positive groups were more likely than their HIV-negative age peers to have prescriptions for statins, pain medications, SSRI antidepressants, and PDE4 inhibitors for respiratory disease.
The researchers concluded that, compared with age- and gender-matched HIV-negative controls, people with HIV had more comorbidities, had more prescriptions for non-ARVs, and were more likely to have prescriptions for more than 5 non-ARVs.
References
1. Koram N, Vannappagari V, Sampson T, Panozzo C. Comorbidity prevalence and its influence on non-ARV comedication burden among HIV positive patients. IDWeek 2013. October 2-6, 2013. San Francisco. Abstract 323.
2. Chu C, Selwyn P. An epidemic in evolution: the need for new models of HIV care in the chronic disease era. J Urban Health. 2011;88:556-566. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3126936/
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