Abstract
Accelerated aging and higher co-morbidity prevalence have increased non-antiretroviral (ARV) medications for HIV patients. We examined, over a 12 month period, non-ARV medication burden among HIV-positive patients 18-49 and ≥50 years using a comprehensive U.S. healthcare claims database in an age-and-gender matched analysis (1:3 matching ratio of cases to controls). Primary outcomes of interest included the median and mean number of unique non-ARV drug substances during the one month period with the highest number of prescriptions filled for each individual, and the mean number of unique classes of medication. We identified 9,510 HIV-positive patients aged ≥50 years and 28,530 controls; 15,737 HIV-positive patients aged 18-49 years and 47,211 controls. Sixty percent of HIV-positive patients aged 18-49 years had ≥1 co-morbidities versus 40% of controls; 82% of HIV-positive patients aged ≥50 years had ≥1 co-morbidities versus 66% of controls. Among patients aged 18-49 years, cases were prescribed 5.3 (±4.2) classes of drugs over 12 months; controls were prescribed 4.2 (±3.4) (p 5 drugs versus 19% of controls. Among patients aged ≥50 years, cases were prescribed 7.2 (±5.3) drug classes versus controls [5.6 (±4.4); p 5 medications versus 32% of controls. Overall, HIVpositive patients were more likely to have ≥1 co-morbidities and be prescribed significantly higher numbers of non-ARV unique drugs and drug classes compared to HIV-negative controls.
Highlights
Since the availability of combination antiretroviral therapy in 1996 in the developed world, HIV infection has gradually become more of a chronic condition, allowing patients to live longer, and resulting in an aging population [1,2]
The prevalence of various co-morbid conditions, including cardiovascular disease, hypertension and diabetes, has increased, and causes of death have gradually shifted from opportunistic infections such as Pneumocystis jiroveci pneumonia (PCP) to endstage liver and kidney disease and non-HIV-related malignancies [1,2]
In an analysis of a U.S health insurance database, it was reported that HIV patients on an antiretroviral therapy (ART) regimen of a single pill a day were more likely to be adherent and less likely to be hospitalized compared with those patients on three or more pills a day [8]
Summary
Since the availability of combination antiretroviral therapy in 1996 in the developed world, HIV infection has gradually become more of a chronic condition, allowing patients to live longer, and resulting in an aging population [1,2]. In an analysis of a U.S health insurance database, it was reported that HIV patients on an antiretroviral therapy (ART) regimen of a single pill a day were more likely to be adherent and less likely to be hospitalized compared with those patients on three or more pills a day [8]. The aging of the HIV-positive population and the increasing prevalence of co-morbidities have resulted in higher non-antiretroviral (ARV) medication burden for this population, as evidenced by several studies. Data from a case-control study in Italy, for instance, indicate that HIV-infected patients, compared to the general population, have a significantly higher risk of acquiring non-infectious co-morbidities, at younger ages [10]. A Canadian study reported that 83% of its HIV-positive participants were taking both ARVs and non-ARVs, and that
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