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.

Conclusions

Analysis of data from 28 089 PLWH receiving ART in Japan showed that the cumulative burden of chronic comorbidities and non-AIDS-defining cancers increased with age and that co-medication was more common among older patients. These findings suggest that special treatment and attention by physicians are needed to support the development of optimal healthcare strategies for different age groups, particularly the increasing population of older individuals. Further, non-AIDS-defining cancers are more common than AIDS-defining cancers, especially among older PLWH. A thoughtful review of the strategies used for screening cancers in older PLWH would probably demonstrate benefits to patient populations.

1 2 3 4 5

Next Section

Acknowledgements
The funder had no role in study design, data analysis, decision to publish, or preparation of the manuscript.

Funding information
This work was supported by Ministry of Health, Labour and Welfare (MHLW) Research on HIV/AIDS Program Grant Number JPMH21HB1005.

Table 1. Demographic and clinical characteristics of the study population
	N = 28 089
	n	(%)
Age group (years)
< 20	34	(0.1%)
20–29	1748	(6.2%)
30–39	6304	(22.4%)
40–49	9820	(35.0%)
50–59	5818	(20.7%)
60–69	2946	(10.5%)
≥ 70	1419	(5.1%)
Sex
Male	25 817	(91.9%)
Female	2272	(8.1%)
AIDS-defining illness	15 957	(56.8%)
AIDS	10 170	(36.2%)
Pneumocystis jirovecii pneumonia	3963	(14.1%)
HIV disease resulting in cytomegaloviral disease	1790	(6.4%)
HIV disease resulting in mycobacterial infection	1750	(6.2%)
HIV candidiasis	806	(2.9%)
Diabetes	12 034	(42.8%)
Hypertension	6808	(24.2%)
Lipid disorders	11 142	(39.7%)
Vascular diseases	3116	(11.1%)
Angina	1778	(6.3%)
Stroke	1541	(5.5%)
Myocardial infraction	362	(1.3%)
Hypertensive heart disease	95	(0.3%)
Chronic kidney disease	1633	(5.8%)
Haemodialysis	168	(0.6%)
Malignant diseases^a	4305	(15.3%)
AIDS-defining cancers	2432	(8.7%)
Non-AIDS-defining cancers	2485	(8.8%)
Psychiatric disorders	8064	(28.7%)
Mania and depression	5526	(19.7%)
Anxiety	4055	(14.4%)
Psychosis	2297	(8.2%)
Dementia	163	(0.6%)
Osteoporosis	3572	(12.7%)
Hepatitis B infection	3935	(14.0%)
Hepatitis C infection	3929	(14.0%)
Other psychoactive substance related disorders	361	(1.3%)

^aNumber of people living with HIV (PLWH) with malignant disease is 4305; PLWH may have more than one type of malignancy.

Table 2. Types of malignancy
Malignancy type	N = 4305
Malignancy type	N	%^a	%^b
AIDS-defining cancers	2432	(49.5%)	(8.7%)
Non-Hodgkin lymphoma	1808	(36.8%)	(6.4%)
Kaposi sarcoma	701	(14.3%)	(2.5%)
Burkitt lymphoma	116	(2.4%)	(0.4%)
Cervix uteri	66	(1.3%)	(0.2%)
Non-AIDS-defining cancers	2485	(50.5%)	(8.8%)
Bronchus and lung	303	(6.2%)	(1.1%)
Liver and intrahepatic bile ducts	277	(5.6%)	(1.0%)
Stomach	228	(4.6%)	(0.8%)
Malignant neoplasm, without specification of site	183	(3.7%)	(0.7%)
Secondary malignant neoplasm of bone and bone marrow	140	(2.8%)	(0.5%)
Secondary malignant neoplasm of brain and cerebral meninges	100	(2.0%)	(0.4%)
Multiple myeloma	98	(2.0%)	(0.3%)
Rectosigmoid junction and rectum	94	(1.9%)	(0.3%)
Secondary malignant neoplasm of lung	86	(1.7%)	(0.3%)
Sigmoid colon	52	(1.1%)	(0.2%)
Oesophagus	47	(1.0%)	(0.2%)
Breast	44	(0.9%)	(0.2%)
Acute myeloblastic leukaemia (AML)	39	(0.8%)	(0.1%)
Skin of trunk	28	(0.6%)	(0.1%)

Note: N = 4305 people living with HIV (PLWH) with malignancy; PLWH may have more than one type of malignancy.
^a% among 4917 malignancies.
^b% among 28 089 total PLWH cohort.

Table 3. The most common non-antiretroviral therapy (ART) medications used in a period of three consecutive months between January and March 2019
	N = 21 865
	n	(%)
Lipid-regulating/anti-atheroma preparations	2475	(11.3%)
Antacids, antiflatulents and anti-ulcerants	2091	(9.6%)
Agents acting on the renin–angiotensin system	1768	(8.1%)
Psycholeptics	1651	(7.6%)
Systemic antimicrobials	1611	(7.4%)
Vitamins	775	(3.5%)
Antidiarrheals, oral electrolyte replacers and intestinal anti-inflammatories	614	(2.8%)
Systemic antibacterial	451	(2.1%)
Anti-inflammatory and anti-rheumatic products	385	(1.8%)
Cough and cold preparations	172	(0.8%)