As They Age, People Living with HIV Getting Other Chronic Conditions.

As antiretroviral therapy (ART) has become more effective and more widely available, people with HIV are living longer—and the average person living with HIV is older. As this population ages, more people living with HIV are also developing other health conditions, according to a new study led by a School of Public Health researcher.

The study, published in Open Forum Infectious Diseases, found prevalences of hypertension, psychiatric disease, liver disease, and pulmonary disorder all likely exceed 30 percent among Medicaid-enrolled people living with HIV. Three quarters of the patients had at least one chronic condition, and a quarter had five or more. The findings have major implications for providers, and for Medicaid, which covers about 40 percent of people living with HIV in the US.

“The care of persons living with HIV is becoming increasingly complex,” says lead study author Megan Cole Brahim, assistant professor of health law, policy & management. “It is critical for policymakers to ensure access to quality care for persons with HIV, while providers, health systems, and health plans serving persons with HIV must better prevent, identify, and manage chronic conditions, coordinate care across multiple specialists, carefully reconcile medications, and ensure proper disease management.”

The researchers used Medicaid administrative claims data from 2003 to 2012 from the 14 states with the highest HIV prevalence, identifying 494,322 patients living with HIV. They then analyzed these patients’ conditions over time, looking at the 10 most common comorbid conditions: cardiovascular disease, any pulmonary disorder, hypertension, diabetes, any liver disease, psychiatric disease, hyperlipidemia, anemia, renal insufficiency, and any indicator for having any HIV-related condition.

From 2003 to 2012, the average age of a Medicaid enrollee living with HIV rose from 40.5 years old to 43.4 years old. During that period, the researchers found that the prevalence of renal insufficiency increased from 3.7 percent in 2003 to 7.8 percent in 2012, hyperlipidemia increased from 9.2 percent to 18.8 percent, psychiatric disease increased from 21.5 percent to 25.7 percent, anemia from 12.3 percent to 16.9 percent, hypertension from 21.2 percent to 31.3 percent, and liver disease from 19.0 to 25.4. The authors wrote that these prevalences are likely even higher, and that the five most common conditions may have a prevalence of more than 30 percent.

In contrast, HIV-related conditions became less prevalent, from 15.8 percent of patients in 2003 to 12.9 percent in 2012, likely thanks to better ART medications and care, the authors wrote.

The average number of comorbid conditions per patient increased from 2.62 to 3.31, and approximately 75 percent of patients had at least one of these conditions.  Patients with five or more conditions increased from 21.1 percent in 2003 to 27.4 percent in 2012.

“Policymakers should be especially attentive” to these findings, Cole Brahim says, noting that Medicaid enrollees living with HIV have healthcare costs five times greater than those without HIV. In addition to improving the health of people living with HIV, she says, “focusing on optimally managing care for this patient population has significant economic implications.”

The study was co-authored by Omar Galárraga, Momotazur Rahman, and Ira Wilson of Brown University School of Public Health.

—Michelle Samuels