A Longitudinal Analysis of Cardiovascular Conditions and Related Comorbidities among Human Immunodeficiency Virus (HIV) Patients in the USA

Background: Patients with HIV infection can present with or develop multiple comorbidities including risk factors for cardiovascular disease (CVD). This study examined CVD and comorbid conditions in HIV patients in the US.

Methods:

Adults diagnosed with HIV (ICD-9 code: 042.xx, 795.71, V08) in 2007-2013 were selected from MarketScan Commercial, Medicare, and Medicaid Databases.  Patients were continuously enrolled for ≥ 365 days in 2007-2013 and were defined as having prior CVD (Myocardial infraction (MI), stroke, deep vein thrombosis, peripheral vascular disease etc.) based on diagnosis or procedure codes. Comorbidities, prevalence (per 1,000 patients) of CVD and MI in 2007-2013 were assessed.

Results: A total of 31,229 HIV patients (mean age: 42.8; male: 77.9%) were selected from the Commercial data, 1,541 (mean age: 71.9; male: 62.7%) from Medicare, and 10,190 (mean age: 42.9; male: 44.1%) from Medicaid. In 2007-2013, CVD and MI prevalence were 70.2 and 16.6 in Commercial, 377.0 and 92.1 in Medicare, and 174.5 and 46.2 in Medicaid. Mean Deyo-Charlson comorbidity index was 6.0, 7.9, and 7.0 in Commercial, Medicare, and Medicaid, respectively. The most common comorbidities were hypertension (Commercial: 32.5%; Medicare:  77.0%; Medicaid: 55.5%), hyperlipidemia (30.6%, 52.7%, 33.8%), diabetes (11.2%, 36.9%, 25.1%), renal impairment (8.3%, 34.6%, 19.1%), and CVD (6.4%, 34.4%, 15.5%). Rates of comorbidities were higher in 2013 than in 2007.  CVD prevalence rose over time (Figure) from 2007-2013.  Among CVD patients, mean number of MI hospitalizations in 2013 were 1.1, 1.0 and 1.0 in Commercial, Medicare, and Medicaid, respectively. MI prevalence in 2013 was 18.9, 77.8, and 37.0 for Commercial, Medicare, and Medicaid.

Conclusion:

HIV patients have multiple comorbidities including CVD risk factors, and the CVD prevalence is rising over time.  As some antiviral regimens may be associated with CVD, understanding CVD risk factors and comorbidities of HIV patients will help optimize care of patients, including choice of antiviral regimens and screening and treating these risk factors.