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Comorbidities Among HIV Patients with Commercial Insurance, Medicare, and Medicaid

Due to living longer and other factors, comorbidities are common in HIV-infected patients on antiretroviral therapy (ART) no matter what type of insurance they have—although some conditions are more prevalent with certain payers.

Because of great advances in antiretroviral therapy (ART) over the past few years, individuals who are infected with HIV are living longer than ever before. However, along with an increased lifespan comes the opportunity to develop a variety of comorbidities. These comorbid conditions may arise thanks to ongoing inflammation in the body, the toxic side effects of ART, or simply the process of aging. What hasn’t been well-studied is the existence of comorbidities in HIV-infected patients in the United States who receive health insurance and coverage from different payers—commercial insurance, Medicaid, and Medicare.

Because of the lack of data on comorbidities among HIV patients in the United States with a range of medical coverage, a team of scientists set out to investigate. Researchers from Southwest CARE Center in Santa Fe, New Mexico, a clinic dedicated to treating people with HIV; the University of California San Francisco; Gilead Sciences; and Truven Health Analytics conducted a retrospective analysis of records from 2003 to 2013. These records included 36,298 patients with prevalent HIV infections who had commercial insurance, 26,246 who were covered by Medicaid, and 1,854 who had Medicare. The patients were matched to a set of controls who did not have HIV.

The researchers found that no matter what kind of health coverage the subjects had, primary hypertension was the most common comorbid condition. Nearly a third (31.4%) of those with commercial health insurance had it, 39.3% of Medicaid patients had it, and more than three-quarters (76.2%) of those with Medicare had it. The second most common comorbidity was hyperlipidemia, or high cholesterol, with 29.2% of commercially covered patients, 22.1% of Medicaid patients, and almost half (49.6%) of Medicare patients having it. Other common comorbidities were endocrine diseases including diabetes (21.8% of commercial-insurance recipients, 27.2% of Medicaid recipients, and 54% of Medicare recipients), diabetes alone (11%, 17.8%, and 37%), and kidney disease (8.4%, 14.7%, and 34.7%).

It’s noteworthy that during the decade from 2003 to 2013, HIV-positive patients in all 3 categories of health care experienced significant increases in the most common comorbidities, as well as rates of obesity. Patients covered by Medicaid and Medicare also saw significant increases in cardiovascular events and had higher rates of bone fractures and osteoporosis during that time. The percentage of those with Medicaid coverage who suffered any cardiovascular event or kidney issues rose from 4.8% to 10.5%.

Compared with the control group, differences in the rates of comorbidities in HIV-positive subjects were statistically significant across all payer categories, although some comorbidities were higher in the HIV-positive group and some were lower—for example, in the commercial-payer category, more HIV-negative control subjects were overweight and suffered from thyroid disease and rheumatoid arthritis than their HIV-positive counterparts. In general, however, HIV-positive subjects had higher rates of comorbidities.

“Among patients covered by commercial payers, a higher proportion with treated HIV infection had any cardiovascular event, myocardial infarction, deep vein thrombosis, peripheral vascular disease, hypertension, hepatitis C, renal impairment, fracture/osteoporosis, endocrine disease (including diabetes), cancer, liver disease, and alcoholism, compared with HIV-negative controls,” the authors wrote, citing similar findings in the Medicaid and Medicare groups with a few exceptions. But in addition to aging, HIV inflammation, and ART toxicity were cited as reasons for these increasing comorbidities in the study population, the authors suggest that a rise in preventive screenings may play a role as well.

According to the researchers, the aging of the HIV-positive population means clinicians should make a habit of screening for other conditions such as cardiovascular disease, kidney problems, and brittle bones. Accurate diagnoses will help providers ensure that patients are taking antiretroviral medications that are appropriate for them and will do the least harm while keeping HIV suppressed.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer- and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.