Heart, Kidney, Bone Disease Rates Higher With Than Without HIV Over 2003-2013
Prevalence of cardiovascular disease, renal impairment and fractures or osteoporosis was higher with than without HIV every year from 2003 through 2013 in a matched comparison of 87,000 people in a commercial insurance database. A similar comparison of 62,000 HIV-positive and negative Medicaid users found a higher prevalence of renal impairment with HIV in every study year and higher cardiovascular and bone disease rates in most years.
Increasing survival of antiretroviral-treated people with HIV has contributed to rising rates of serious non-AIDS diseases. To assess time trends of important comorbidities and to compare their prevalence in HIV-positive people and matched HIV-negative controls, researchers at the University of California, San Francisco, and other centers retrospectively analyzed patients in a commercial insurance database and a Medicaid database. Commercial or Medicaid patients had at least six months of continuous care before and after their earliest HIV diagnosis during the years 2003-2013, and all started antiretroviral therapy. For each HIV patient, the researchers selected up to three controls matched for insurance database, five-year age group, gender, race (Medicaid patients only), calendar year of index date and geographic region.
The analysis included 21,180 HIV-positive people and 66,027 HIV-negative controls in the commercial database, 84% of them men, with an average age of 48 years. The Medicaid database provided 16,431 HIV cases and 45,556 controls, 54% of them men, with an average age of 50 years. Among people with HIV, median age in the commercial database rose from 44 years in 2003 to 48 in 2013. Among Medicaid patients with HIV, median age rose from 42 years in 2003 to 48 in 2013.
Over the full study period in the commercial database, prevalence of cardiovascular events, renal impairment, fractures/osteoporosis, hypertension, hepatitis C (HCV) infection, hyperlipidemia and endocrine disease were higher in people with HIV. In the Medicaid database the HIV group had higher prevalence of cardiovascular events, renal impairment, fractures/osteoporosis, hypertension, HCV infection and endocrine disease.
For HIV-positive people in the commercial database, who represent a population with the best health care access in the United States, prevalence of five comorbid conditions rose from 2003 to 2013: diabetes (6% to 9%), hypertension (10% to 25%), hyperlipidemia (10% to 23%), obesity (1% to 5%) and endocrine disease (10% to 16%). Rates of those same conditions rose from 2003 to 2013 in the HIV Medicaid group: diabetes (9% to 17%), hypertension (16% to 47%), hyperlipidemia (8% to 29%), obesity (2% to 12%) and endocrine disease (14% to 24%). All these rates were higher than in the similarly aged commercial HIV population, and all 2003 to 2013 increases in the Medicaid group were statistically significant (P < .05).
In both the commercial and Medicaid databases, the proportion of patients with renal impairment for each year was higher in the HIV group than in HIV-negative controls. For most years analyzed, the proportion of patients with a cardiovascular event was higher with HIV in both the commercial database and the Medicaid database. For all years except 2012, the proportion of people with a fracture or osteoporosis was higher in HIV Medicaid cases than in controls. In the commercial database, fracture or osteoporosis prevalence was higher in every year among people with HIV.
The researchers stressed that certain antiretrovirals are associated with renal impairment, cardiovascular disease and bone disease. Thus "understanding risk factors for these conditions ... [in] HIV patients in differing payer groups will help optimize care of patients," including screening for and treating risk factors and selecting an appropriate antiretroviral regimen.