Greater burden of chronic comorbidities and co-medications among people living with HIV versus people without HIV in Japan: A hospital claims database study

Abstract

Objective: This study examined the prevalence of chronic comorbidities and the use of co-medications among people living with HIV (PLWH) on antiretrovirals in Japan, compared with age-matched controls without HIV. Methods: This was an observational, retrospective, cross-sectional study using a hospital claims database of Japanese hospitals with advanced medical capabilities (i.e., advanced treatment hospitals, general hospitals, acute care hospitals). We extracted data for PLWH aged !18 years with a prescription record of antiretrovirals between January 2010 and December 2015, and for age-, sex-, and hospital-matched people without HIV. For each group, chronic comorbidities (diabetes, hypertension, lipid disorders, vascular diseases, chronic kidney failure, cancers, psychiatric disorders, osteoporosis, and hepatitis B/C co-infection), and co-medications were examined by age group. Results: We analyzed data for 1445 PLWH and 14,450 people without HIV. The proportion of patients with multiple comorbidities was much greater among PLWH than controls of the same age group. Lipid disorders and diabetes were more prevalent in PLWH than controls (31.6% vs. 10.3% and 26.8% vs. 13.2%, respectively), both of which were more common in PLWH at earlier ages. Cancer was present in 8.1% of PLWH and 8.9% of controls. A greater proportion of PLWH used multiple co-medications other than antiretrovirals at earlier ages than controls. Conclusion: PLWH taking antiretrovirals in Japan had a greater burden of comorbidities and comedications with increasing age than people without HIV. In addition to appropriate management of comorbidities, medication reconciliation according to patients' co-medication profiles is important for successful management of this patient population.

What do the changing patterns of comorbidity burden in people living with HIV mean for long‐term management? Perspectives from European HIV cohorts

“…Interestingly, in an observational, retrospective Japanese hospital claims database study, PLWHIV on ART were not only found to have a higher comorbidity burden (lipid disorders, diabetes, psychiatric disorders and hepatitis B/C co-infection) than age-matched controls without HIV, but this burden occurred at an earlier age, supporting similar observations in ageing cohorts in Brazil [21,22]. In a separate study (French Dat'AIDS cohort), with the exception of dyslipidemia, comorbidities were even more frequent in the geriatric (≥ 75 years of age) HIV -positive population compared to the elderly (50-74 years of age) HIV-positive populations with 18.4% vs. 4.3% experiencing 4 or more comorbidities, respectively.…”

“…Although limited in number, the excess comorbidity burden in PLWHIV vs. appropriately age-matched HIV-negative populations has been reported [18][19][20][21]. For instance, in the Australian Positive & Peers Longevity Evaluation Study (APPLES), HIV-positive gay and bisexual men had significantly greater odds of diabetes (OR = 1.97; 95% CI: 1.04-3.75), thrombosis (OR = 3.08; 95% CI: 1.36-6.98) and neuropathy (OR = 34.6; 95% CI: 8.9-134.5) and non-significantly increased odds for heart-disease (OR = 1.71; 95% CI: 0.94-3.1) vs. a matched HIV-negative population [18].…”

Safety of Gabapentin Prescribed for Any Indication in a Large Clinical Cohort of 571,718 US Veterans with and without Alcohol Use Disorder

“…Similar to patients with current AUD, our subgroup analysis of patients with HCV and HIV demonstrated elevated incidence of adverse events regardless of gabapentin exposure, which may reflect baseline risk for these adverse outcomes due to increased rates of medical and psychiatric comorbidities and potential medication interactions (Evon et al, 2018;Ruzicka et al, 2019). In contrast to our findings, one small randomized controlled trial comparing the effect of gabapentin with placebo in HIV-associated sensory neuropathy found that participants receiving gabapentin were more likely to report somnolence (12/15 for gabapentin and 2/11 for placebo; p = 0.006), dizziness (9/15 for gabapentin and 5/11 for placebo; p = 0.305), and gait disturbance (7/15 for gabapentin and 3/11 for placebo; p = 0.357) (Hahn et al, 2004).…”

Liver bacterial dysbiosis occurs in SIV-infected macaques and persists during antiretroviral therapy

“…With the introduction of highly effective combination antiretroviral therapy (cART), persons infected with HIV now have a life expectancy that is closer to that of the general population, particularly in higher income countries [2,3]. Nevertheless, HIV-infected (HIV+) individuals experience a greater burden of co-morbidities, often at a markedly younger age, including cardiovascular disease, frailty, cognitive decline and liver disease [4][5][6]. Among these chronic health conditions, liver disease is especially prevalent, most notably non-alcoholic fatty liver disease (NAFLD), and is a leading cause of death in HIV + individuals [7,8].…”