icon-folder.gif   Conference Reports for NATAP  
  ICAAC 2015 55th Interscience Conference
on Antimicrobial Agents and Chemotherapy
September 5-9, 2015, San Diego, CA
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Alarmingly High Comorbidity Rates Among HIV+
  ......Aging a problem about to Explode but not receiving adequate attention from Federal & State governments......
Comorbidity Rates in HIV+ on Medicare in 2013: cardiovascular events 15.9% up from 9.6% in 2003; chronic kidney disease 16% up from 5% in 2003; renal impairment 20% up from 9.2% in 2003; hypertension 65% up from 34% in 2003; diabetes 31% up from 20% in 2003; hyperlipidemia 47.4% up from 12.1% in 2003; fractures or osteoporosis 11.2% up from 6.7% in 2003...HCV is 13% in medicaid in 2013
Increasing Comorbidities in HIV+....of note the average age of patients in medicaid in this analysis is only 45 (11.2).....these increased & high rates will continue to increase as patients age, death rates will increase....also worrisome will be depression, suidical ideation, mobility problems, housing & income problems, and not mentioned....in speaking with high volume HIV clinics they tell me 50% of their older patients are on antidepressants
"HIV patients are aging and present with a number of comorbidities"

Renal Impairment Doubles Among Medicaid & Commercial Insurers, and triples among medicare with 16% prevalence of chronic kidney disease
.....Cardiovascular Events Doubled in Medicaid, and Up 50% in Medicare with 16% reporting cardiovascular events
48% Have Hypertension in medicaid. 65% in medicare.....Rates of Hypertension Doubled Among Commercial & Medicare & Tripled Among Medicaid Patients from 2003 to 2013
.....31% have diabetes in medicare....Diabetes Rates Doubled Among Medicaid & Increased 50% among Medicare & Commercial 47% in medicare have hyperlipidemia....Elevated Lipids Quadruples Among Medicaid & Medicare & Doubles in Commercial
....Fracture or Osteoporosis Rates increased about 40% in medicaid, doubled in medicare & increased 20% in commercial, and I suspect these are underestimated because many clinicians are not testing with a bone dexa.
......Hepatitis C -14% reported having HCV in Medicaid 2013, in Medicare 2.5% report having HCV which doubled from 2003, while in commercial insurance the rates were about the same reported in 2003 & 2013 (3.0%, 2.6% respectively). Thus the higher HCV rates & increasing HCV rates in medicaid reflect starkly the disproportionate affect of HCV among the poor & more marginalized and thus African-Americans & Latinos & those with a history of IDU
Comorbidities of Patients with Human Immunodeficiency Virus (HIV) in the USA - a Longitudinal Analysis of Prevalent HIV Patients Over 11 Years
Reported by Jules Levin
ICAAC 2015
N. Meyer1, J. E. Gallant2, P. Hsue3, X. Song1; 1Truven Hlth. Analytics, Cambridge, MA, 2Southwest CARE Ctr., Sante Fe, NM, 3UCSF Sch. of Med., San Francisco, CA
Background: Patients with HIV infection can present with multiple comorbidities prior to and following the initiation of antiretroviral therapy (ART) including potential risk factors for cardiovascular disease (CVD) and renal impairment and osteoporosis/fracture. Understanding these risk factors can help identify patients at high risk and help optimize HIV treatment. Methods: Adults diagnosed with HIV (ICD-9-CM code: 042.xx, 795.71, V08) in 2002-2013 were selected from MarketScan Commercial, Medicare, and Medicaid databases, which are longitudinal, allowing patients to be observed over multiple years. All patients were continuously enrolled for at least 1 calendar year during 2003-2013. Age and gender entered on the date of the first HIV diagnosis. Comorbid conditions during calendar years 2003-2013 were assessed using diagnosis and procedure codes.
Results: In 2003, 18,944 HIV-infected patients (med. age: 42, 62.4% male) met study criteria; in 2013, 20,355 patients (med. age: 48, 69.3% male) met study criteria. Among prevalent HIV patients, lower rates of comorbidities and events were observed in 2003 than 2013: diabetes (8.3% vs 12.7%),hypertension (15.7% vs 32.2%), hyperlipidemia (7.7% vs 24.3%), CVD (2.9% vs 4.3%), and renal impairment (4.4% vs 7.0%). Separate results for Commercial, Medicare, and Medicaid are shown in the Table.
Conclusions: Prevalent HIV patients are aging and present with a number of comorbidities, including renal and CVD. The prevalence of these comorbidities has risen since 2003. Understanding these risk factors can help identify patients at high risk and optimize HIV treatment.