People with HIV who have other medical conditions such as high blood pressure or high lipids appear to do better if they have a primary care physician as well as an HIV physician, according to a study of people receiving care through UCLA Center for Clinical AIDS Research and Education, researchers report in The Journal of Infectious Diseases.
A second study, looking at chronic medical conditions, or co-morbidities, in a large sample of people with HIV in the United States found that high blood pressure (hypertension), elevated lipids and endocrine disorders (including diabetes) were the most common co-morbid conditions, and that the proportion of people with HIV in care also receiving treatment for several co-morbid conditions rose significantly between 2003 and 2013.
As people with HIV grow older and HIV infection becomes increasingly well-controlled through antiretroviral treatment, a growing proportion of the care needed by people with HIV is for chronic medical conditions. Some are related to HIV infection or may be exacerbated by long-term inflammation due to HIV. Antiretroviral treatment may also increase the prevalence of some conditions, including high lipid levels, reduced kidney function, fractures and osteoporosis.
To find out which co-morbid conditions are more common in people with HIV, US researchers carried out a review of claims submitted to US health insurance companies, to Medicare and to Medicaid between 2003 and 2013 relating to all medical care apart from HIV diagnosis. The study identified claims relating to 36,298 people with HIV insured by commercial insurance companies, 26,246 by Medicaid (means-tested free insurance coverage for certain categories of US citizens) and 1854 by Medicare (health insurance for people aged 65 and over or qualifying disabled people).
The most common co-morbidities were hypertension, hyperlipidaemia, endocrine disease (including diabetes), diabetes and renal impairment. The frequency of each co-morbidity was higher among Medicare claimants, who had a mean age of 71.5 years, compared to 41.6 years in the Medicaid group and 42.2 in the commercial insurance group. Claims relating to cardiovascular events and to renal impairment more than doubled between 2003 and 2013, as did claims for hyperlipidaemia.
When claims for HIV-positive people were compared with a demographically matched control group of HIV-negative people from the same insurance databases, commercially insured people with HIV were more likely to have undergone treatment for cardiovascular disease, deep vein thrombosis, hypertension, hepatitis C, renal impairment, fracture or osteoporosis, cancer, liver disease or alcoholism (p < 0.001). A similar pattern held true for people covered by Medicaid. Deep vein thrombosis, renal impairment and cancer were more frequent in HIV-positive people covered by Medicare compared to HIV-negative controls (p < 0.05).
The study authors say that part of the explanation for an increase in prevalence over time could lie in improved access to screening as a result of the 2010 Affordable Care Act, together with greater use of electronic medical records. Nevertheless, the high prevalence of co-morbidities observed in this study has also been reported in studies in the Netherlands and Switzerland, suggesting that the results are not simply a consequence of improvements in screening and recording.