Methods: Adults diagnosed with HIV (ICD-9 code: 042.xx, 795.71, V08) in 2006-2013 were selected from MarketScan Commercial and Medicaid Databases. All patients were continuously enrolled for ≥ 365 days in 2007-2013. Comorbidities, CVD, and fractures were examined using diagnosis and procedure codes.
Results: A total of 31,229 HIV patients (mean age: 42.8; male: 77.9%) were selected from the Commercial database, and 10,190 (mean age: 42.9; male: 44.1%) from Medicaid. Prevalence and incidence rates of CVD and fractures were higher among Medicaid compared to Commercial patients. In 2007-2013, fracture prevalence (per 1000 patients) and incidence (per 1000 patient-years) were 83.1 and 22.1 in Commercial and 191.2 and 42.5 in Medicaid; CVD prevalence and incidence were 70.2 and 18.4 in Commercial, and 174.5 and 41.6 in Medicaid. Mean Deyo-Charlson comorbidity index was 6.0 for Commercial and 7.0 for Medicaid patients. The most common comorbidities were hypertension (Commercial: 32.5%; Medicaid: 55.5%), hyperlipidemia (30.6%, 33.8%), endocrine disease (including diabetes) (22.3%, 35.3%), renal impairment (8.3%, 19.1%), and general CVD event (6.4%, 15.5%), all p<0.001. For both Commercial and Medicaid, HIV patients had more comorbidities, CVD and fractures in 2013 than in 2007.
Conclusion: HIV patients can present with a number of comorbidities, including risk factors for CVD and bone fractures. These comorbidities and events have increased over time, and are consistently higher in Medicaid than in commercially insured patients. Additionally, Medicaid patients are more likely to be female and have a higher comorbidity and event/disease burden, further changing their risk profiles. Understanding these differing risk profiles is important when making optimal choices in treatment of HIV.
X. Song, None
G. Mccomsey, Gilead Sciences: Consultant , Consulting fee