Comorbidities and Co-Medications Among 28 089 People Living With HIV

A Nationwide Cohort Study From 2009 to 2019 in Japan

Toshio Naito; Mai Suzuki; Shinichi Fukushima; Mayumi Yuda; Nobuyuki Fukui; Shotaro Tsukamoto; Kazutoshi Fujibayashi; Keiko Goto-Hirano; Ryohei Kuwatsuru

Disclosures

HIV Medicine. 2022;23(5):485-493. 

In This Article

Results

Population Characteristics

The demographic and clinical characteristics of the patients are shown in Table 1. A total of 28 089 PLWH were included. Of these, 15 957 (56.8%) had diseases that define AIDS. Men comprised 91.9%, with the most common age range being 40–49 years (9820, 35.0%), followed by 30–39, 50–59, 60–69, 20–29, and ≥ 70 years.

Chronic Comorbidities

Between 2009 and 2019, a cumulative total of 22 881 (81.5%) patients reported chronic comorbidities, and a cumulative total of 10 020 (35.7%) patients recorded three or more chronic comorbidities. The most frequent comorbidities, as shown in Table 1, were diabetes (42.8%), lipid disorders (39.7%), psychiatric disorders (28.7%) and hypertension (24.2%). Coinfection with HCV and HBV infection were similar (14.0%).

Figure 1(a) shows the number of chronic comorbidities by age group. Although > 70% of patients aged 20–29 years had one or no chronic comorbidities, the proportions of patients with no chronic comorbidity decreased as age increased; that is, greater numbers of chronic comorbidities were found in the older age groups, with 39.1% (2462/6304) of patients aged 30–39 years, 69.7% (4052/5818) of patients aged 50–59 years, and 88.7% (1259/1419) of patients aged ≥ 70 years having two or more chronic comorbidities. Of patients aged ≥ 70 years, 53.6% (760/1419) had four or more chronic comorbidities.

Figure 1.

(a) Number of chronic comorbidities or infections by age group. (b) Types of chronic comorbidities or infections by age group

Figure 1(b) shows the prevalence of different types of comorbid clinical conditions by age group. Distributions in the proportion of psychiatric disorders, HBV and HCV were similar across different age groups (from 20–29 to ≥ 70 years old). All other comorbid clinical conditions tended to be higher in the older age groups. The most common chronic comorbidities in the older age groups were diabetes, hypertension and lipid disorders. Diabetes was the most common chronic comorbidity in the age groups 50–59 years [51.4%, 95% confidence interval (CI): 50.8–52.0], 60–69 years (62.2%, 95% CI: 61.3–63.0) and ≥ 70 years (67.9%, 95% CI: 66.8–69.1).

Malignancies

Table 2 shows the proportion of different types of malignancies among the PLWH with malignancies. Among this group, some have more than one type of malignancy. Therefore, a total of 4917 malignancies was reported among 4305 PLWH with malignancies: 2432 (8.7%) AIDS-defining cancers and 2485 (8.8%) non-AIDS-defining cancers. Non-Hodgkin lymphoma was the most common type of AIDS-defining cancer (6.4%), and bronchus or lung cancers were the most common type of non-AIDS-defining cancers (1.1%).

Stratification of patient demographics, comorbidities and proportion of different types of malignancy among PLWH receiving ART by year (2009–2019) is presented in Tables S1 and S2. Changes in trend between 2009 and 2019 include the following: (1) an increase in the number of elderly PLWH: the proportion of patients aged ≥ 70 years with an HIV diagnosis was higher in 2019 (4.7%) than in 2009 (2.4%); (2) an increase in the presence of the comorbidities hypertension (12.3–20%) and osteoporosis (2.7–9.3%); (3) a continually decreasing trend in the number of patients with AIDS-defining cancers, from 6.3% to 4.8%, between 2009 and 2019; (4) a decrease in the proportion of PLWH with HCV infection, from 12% to 8.4%, but no change in the proportion of HBV infection between 2009 and 2019 – this is probably due to the effectiveness of new medication for HCV, and low acceptance of HBV vaccine in Japan.

Co-medications

Depending on the definition of the included period, the most common non-ART medications differ. Table 3 shows that the common co-medications during the most recent 3-month period (between January and March 2019) 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%). Table S3 shows the common non-ART medications used during the 10-year study period. The three most common therapeutic categories were antacids, antiflatulents and antiulcerants (35.0%); systemic antihistamines (33.7%); and psycholeptics (27.1%).

Figure 2 shows the number of non-ART co-medications prescribed concomitantly for three consecutive months during January to March 2019. It was also observed that more patients in the older age groups used greater numbers of non-ART co-medications. The proportions of patients using three or more non-ART co-medications were < 5% for those aged < 50 years, 7.3% for those aged 50–59 years, 10.8% for those aged 60–69 years, and 15.7% for those aged ≥ 70.

Figure 2.

Number of non-antiretroviral therapy (ART) co-medications by age group. Co-medication was defined as the number of non-antiretroviral medications prescribed concomitantly for three consecutive months during January–March 2019. Note that the bar graph for the age group 20–29 years is not shown, in order to ensure patient privacy (in accordance with the regulations of the Japan Ministry of Health, Labour and Welfare, counts are not to be disclosed)

Figure S1 shows the number of non-ART co-medications prescribed concomitantly for ≥ 90 cumulative days during the study period, by age group. Among 28 089 PLWH, 21 442 (76.3%) used at least one co-medication and 3749 (13.4%) used five or more non-ART co-medications. The proportions of patients who used at least one co-medication were 49.5% (866/1748) for those aged 20–29 years, 78.1% (7666/9820) for those aged 40–49 years, and 90.9% (1290/1419) for those aged ≥ 70 years. More patients in the older age groups used greater numbers of co-medications, and the proportions of patients using four or more co-medications by age group were: 12.8% (808/6304) for those aged 30–39 years, 29.9% (1737/5818) for those aged 50–59 years, and 40.3% (572/1419) for those aged ≥ 70 years. Antacids, antiflatulents and anti-ulcerants were the most common co-medications in most age groups, especially in those who were aged 70 or older (61.2%; 868/1419). Systemic antihistamines, psycholeptics and systemic antimicrobials was used mostly commonly among the age groups 40–49 (37.8%), ≥ 70 (31.6%) and 50–59 years (28.2%). Lipid-regulating agents were used more commonly in the older age groups, being used in 30.0–40.3% of patients aged ≥ 50 years.

processing....