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More Non-HIV Illnesses With HIV Than Without, But Less Treatment
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First International Workshop on HIV and Aging, October 4-5, 2010, Baltimore
Mark Mascolini
HIV-infected people had a higher prevalence of noninfectious non-AIDS conditions in a large Italian case-control comparison [1]. But the HIV group got drugs for these conditions less often than the non-HIV group. The study found evidence that hypertension, in particular, is undertreated in people with HIV.
Researchers at Modena University compared drug use prevalence and pill burdens in 2854 consecutive patients seen at the HIV outpatient clinic in 2009 and 8562 controls from the CINECA ARNO Observatory database. Controls were matched to the HIV patients by age, gender, race, and geographical region. The CINECA ARNO database records vital statistics, prescriptions, hospital admissions and discharges, and diagnostic tests and examinations on 11 million people across the country. The investigators used the Anatomical Therapeutic Chemical system to classify drugs, and they excluded drugs taken for fewer than 30 days. Study group age averaged 45.9 +/- 7.6 years, and 37% were women.
Rates of multiple noninfectious comorbidities were consistently higher in people with HIV than in HIV-negative controls, regardless of age group:
-- 40 or younger: 3.9% with HIV versus 0.5% without HIV
-- 41 to 50: 9.0% with HIV versus 1.9% without HIV
-- 51 to 60: 20.0% with HIV versus 6.6% without HIV
-- Over 60: 46.9% with HIV versus 18.7% without HIV
Analyzing 26,397 drug records, the Modena team charted higher use rates in the HIV group than in the control group for gastrointestinal and metabolism drugs (26% versus 17%, P < 0.001), antineoplastic (anticancer) and immunomodulating agents (2% versus 1%, P = 0.003), and nervous system drugs (14% versus 11%, P < 0.001). These higher rates in people with HIV held true across the four age brackets analyzed. Gastrointestinal and metabolism drugs included agents for liver disease, antidiarrheals, and proton pump inhibitors. Antineoplastic and immunomodulating drugs included interferon.
HIV-negative controls had significantly higher use rates for cardiovascular drugs (42% versus 40%, P = 0.011), genitourinary and sex hormone agents (5% versus 2%, P < 0.001), and respiratory system medications (4% versus 0%, P < 0.001).
Higher cardiovascular drug use in the HIV-negative controls may be partly explained by apparent undertreatment of hypertension in people with HIV. The investigators found a significantly higher hypertension prevalence in HIV-positive people in every age group over 40 (P < 0.001). But prevalence of antihypertensive therapy was significantly lower in the HIV group in every age stratum (P < 0.001). For example, among 51-to-60-year-olds, 39% of people with HIV had hypertension compared with 32% of people without HIV. But 24% of people with HIV got antihypertensive therapy versus 39% of people without HIV.
Median pills per day excluding antiretrovirals were higher in the HIV group in every age bracket. When the investigators counted antiretrovirals, median pills per day were higher in HIV-infected people in every age bracket: under 40 (4.0 with HIV versus 0.0 without HIV), 41 to 50 (6.0 with HIV versus 0.27 without HIV), 51 to 60 (6.0 with HIV versus 0.88 without HIV), and over 60 (9.0 with HIV versus 0.93 without HIV) (P < 0.001 for all comparisons).
Logistic regression analysis determined that multiple noninfectious comorbid conditions were significantly more likely in the HIV group (P < 0.001). But among people with multiple comorbid illnesses, polypharmacy (5 or more drugs a day) was significantly less likely in the HIV group (P < 0.001). The investigators concluded that undertreatment is more common in people with HIV than in those without HIV. The study does not address whether this undertreatment is explained more by underprescribing by HIV physicians or by reluctance of HIV-infected people to add more drugs to their regimen.
Reference
1. Guaraldi G, Menozzi M, Zona S, et al. Polypharmacology for polypathology in HIV infected patients. First International Workshop on HIV and Aging. October 4-5, 2010. Baltimore. Abstract O_09.
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