Diagnoses of non-HIV chronic diseases in older PLWH are on the rise, but the reasons behind the rise may be complex, according to results published in Open Forum Infectious Diseases of a single-site study in a Ryan White-funded HIV clinic in the U.S. Southeast that served both urban and rural patients.
The study, which was conducted by University of Virginia researchers (the clinic was not named in the manuscript), compared multimorbidity among two cohorts of participants aged ≥ 45 years. One cohort was recruited among the clinic population in 2006 (n = 149) and the other in 2016 (n = 323). The clinic population itself aged during that span; in 2006, 70% of the cohort was between the ages of 45 and 54, with 30% age 55 or older; in 2016, 48% of the cohort was between 45 and 54, with 52% age 55 or older.
The researchers found that 19% of participants in the earlier cohort and 30% in the later one were diagnosed with at least two chronic diseases. That said, researchers noted that the Affordable Care Act was passed in 2010, between the two cohorts. Although the clinic is located in a state that did not expand Medicaid eligibility, more participants had health insurance in 2016 than in 2006. That fact, combined with ACA coverage requirements, may account for the increase in diagnoses due to better health care access, the study authors suggested: Multimorbidity was particularly less common among those with private health insurance, possibly because of better preventive care coverage, such as pharmacotherapy for smoking cessation.
Findings were nuanced with respect to racial and sex-based differences: In 2006, Black participants (who comprised roughly half of each cohort) were less engaged in care than those of other races, but no such disparity was found in 2016; study authors hypothesized that this may in part because during the intervening decade, the clinic had hired additional case managers and implemented a peer coaching program.
In 2016, multimorbidity was much more common among women than men, which the study authors said may be related to higher obesity rates among women on newer antiretrovirals, such as TAF and INSTIs.
“The RWHAP [Ryan White HIV/AIDS Program] and RWHAP Part D could invest in addressing these disparities related to insurance and gender,” study authors concluded.