Abstract and Introduction
Objectives: Comorbidities are associated with a high burden of disease in people living with HIV (PLWH). The objective was to investigate the prevalence of chronic comorbidities and use of co-medications in PLWH in Japan.
Methods: This study retrospectively analysed clinical information from PLWH receiving antiretroviral therapy (ART) between April 2009 and March 2019. Demographic characteristics, numbers and types of chronic comorbidities, and numbers and types of non-ART co-medications, were described by age groups. The source of data was the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB).
Results: Overall, 28 089 PLWH (male 91.9%) who used ART were identified. Out of 28 089 PLWH, 81.5% had at least one chronic comorbidity. The numbers of AIDS-defining cancers and non-AIDS-defining cancers in this Japanese cohort were 2432 (8.7%) and 2485 (8.8%), respectively. The cumulative burden of comorbidities including non-AIDS-defining cancer increased with age. Changes in trend between 2009 and 2019 were observed, including a higher proportion of PLWH diagnosed at ≥ 70 years old [2019 (4.7%) vs. 2009 (2.4%)] and a decreasing percentage of patients with AIDS-defining cancers (down from 6.3% to 4.8% between 2009 and 2019). The most common co-medications during the most recent 3-month period were lipid-regulating/anti-atheroma preparations (11.3%), antacids, antiflatulents and anti-ulcerants (9.6%), and agents acting on the renin–angiotensin system (8.1%). The three most common therapeutic categories of co-medications during the study period were antacids, antiflatulents and anti-ulcerants (35.0%), systemic antihistamines (33.7%) and psycholeptics (27.1%). More than 30% of PLWH aged > 40 years used at least one co-medication in a 3-month period, while more than half of PLWH aged > 30 years had at least one co-medication prescribed concomitantly for a total of ≥ 90 days during the study period, and the numbers of co-medications used were greater in the older age groups.
Conclusions: The burden of chronic comorbidities and co-medication were found to be greater in older, as compared to younger patients, among 28 089 PLWH in a nationwide study in Japan. This finding suggests the need to identify elderly PLWH and to appropriately manage their HIV and comorbidities.
The advent of antiretroviral therapy (ART) and ongoing improvements during the last 20 years have prolonged the life expectancy of PLWH, such that these patients may now live as long as HIV-negative individuals. However, various international studies have shown that age-associated chronic comorbidities, combined with HIV-associated conditions, have a negative effect on mortality rates of people living with HIV (PLWH).[2–4] Previous studies have also shown that > 50% of HIV deaths are caused by either coinfection or age-associated non-infectious chronic comorbidities, most notably vascular diseases, hypertension, lipid disorders, diabetes mellitus, chronic kidney disease (CKD), with or without dialysis, malignancies, and bone disorders.[2,5,6]
As a result of the global ageing of society, new challenges have emerged in the management of HIV, including age-associated chronic comorbidities in PLWH. These challenges take on added significance in Japan, which has the longest reported life expectancy worldwide. A study in 2015 reported that > 10% of newly diagnosed PLWH in Japan were aged ≥ 50 years, supporting the finding that a significant number of HIV patients are relatively older. Although the majority of newly diagnosed HIV patients in the 2015 study were aged 20–49 years (88.2%), these patients are now considered more likely to live to old age because they are projected to be appropriately managed with ART. The number of older adult PLWH appears to be increasing in Japan, corresponding to trends in other countries that are reporting increased proportions of PLWH aged ≥ 50 years.[9–11] Because of the potentially long life spans of PLWH in developed countries, it becomes central to adequate planning to update the real-world epidemiological data of the HIV population, particularly comorbidity profiles and the use of co-medication data.
Despite the potential significance of the associations between chronic comorbidities and HIV mortality rates, only a few small studies regarding chronic comorbidities and infections in PLWH in Japan have been published to date.[12,13] Our group previously examined chronic comorbidities and use of co-medications among PLWH in Japan who were using antiretrovirals, obtaining patient data from a commercial hospital claims database.[14,15] However, although the commercial database included data from relatively large hospitals, the total HIV patient population studied was 1445 individuals. Results of these prior studies found that older adult PLWH on antiretrovirals had more chronic comorbidities and used more co-medications than their younger counterparts, suggesting potential issues regarding appropriate management for this older patient population. This observation led to the hypothesis that updated epidemiological data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) could be used to expand and confirm these previous findings and help to gain a better understanding of the challenges associated with coexisting diagnoses in Japanese PLWH. This is the first report to analyse comorbidities and use of co-medications among all patients in the national database, which contains data on the largest number of PLWH in Japan available to date.
HIV Medicine. 2022;23(5):485-493. © 2022 Blackwell Publishing