Higher Burden of Chronic Comorbidities Among Aged Hospitalized HIV Patients Compared to Non- HIV Infected Patients in Japan
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1 Higher Burden of Chronic Comorbidities Among Aged Hospitalized HIV Patients Compared to Non- HIV Infected Patients in Japan Daniel J. Ruzicka, M.D., M.Sc. 1 ; Kentaro Imai, M.D., M.P.H. 1 ; Kenichi Takahashi 1 ; Toshio Naito M.D., Ph.D. 2 1 Medical Affairs, MSD K.K., Japan; 2 Dept. of General Medicine, Juntendo University School of Medicine, Japan
2 Disclaimer/COI Daniel Ruzicka, Ken Imai, and Ken Takahashi are all employed by MSD K.K., Tokyo, Japan Toshio Naito has received no funding in regards to this study, but has the following financial disclosures: Consultant fees from Nobel pharma Co. Ltd. and Tsumura & Co. Speaker fee from MSD KK and research fund from Pfizer Inc. A member of endowed laboratories funded by ML partners and Fujitsu Limited.
3 % 50 Years of Age or Older Background Aging With HIV Men Women Median age Year of Follow-Up (year) Marcus JL, et al. J Acquir Immune Defic Syndr. 2016;73(1): Costagliola D. Curr Opin HIV AIDS. 2014;9(4): HIV patients have longer life expectancy than ever before.
4 Daily Long-Term Medications Background Aging With HIV Percentage by Age Group Diagnosed with Comorbid Conditions Veterans Aging Cohort Study: median number of daily long-term medications by HIV status and age. Thin black bar indicates the corresponding 95% confidence interval Age (years) 0 < Age (years) Coronary Artery Disease Hypertension Renal Disease Hyperchlosterolemia Diabetes Uninfected, n=47613 HIV-infected, n=16324 Vance DE, et al. J Assoc Nurses AIDS Care. 2011;22(1): Available at: Edelman EJ, et al. Drugs Aging. 2013;30(8): Number of chronic comorbidities is high in HIV patients. HIV patients use multiple drugs.
5 Study Objective To describe and compare frequency and type of chronic disease comorbidities of interest among HIV-infected patients >18 years of age in a Japanese hospital-based database to an age-, gender-, and location (institution/hospital)-matched, non-hiv-infected patient group by age group To describe and compare current comedication for comorbidities
6 Methods Database This is an observational, retrospective, cross-sectional study, using a hospital-based claims database constructed by Medical Data Vision Co., Ltd. (Tokyo, Japan) MDV Database includes 288 hospitals (all acute hospitals, DPC hospitals, approx. 17% of all acute hospitals in Japan) approximately 17 million patients (as of January 2017)
7 Methods Inclusion HIV patients aged 18 years and with a prescription record of ART between January 2010 and December 2015 were included for the analysis Non-HIV-infected patients registered in the same database were matched according to age, gender, and hospital/institution Based on age at the time of last hospital visit, subjects were grouped into 6 groups by age: 18-29, 30-39, 40-49, 50-59, 60-69, and 70 years old
8 Methods HIV was defined as International Classification of Diseases, 10th revision (ICD-10), codes B20-B24 Comorbidities included in this analysis were defined based on ICD-10 codes as shown Description of Comorbidity Groups Comorbidity Groups Diabetes Hypertension Lipid disorder Chronic vascular disease Chronic kidney disease Malignancy Psychiatric disorders Bone disorder Co-infection (hep B/C) Included Pathologies Diabetes type II Hypercholesterolemia Hyperlipidemia Prior myocardial infarction Stroke Angina pectoris Coronary arterial bypass grafting Angioplasty NYHA >1 Chronic renal failure Renal lithiasis Any malignancy Depression Chronic anxiety Mania Psychosis Dementia Insomnia Osteoporosis Chronic hepatitis B Chronic hepatitis C
9 Number of Patients Results Demographics Number of HIV Patients and Sex by Age Groups Age Groups 1,445 patients who had a prescription record of ART enrolled from 47 hospitals and 14,450 non-hiv-infected patients (1:10 matching) were identified in the database The mean age for HIV-infected/non-HIV-infected patients was 47.0±12.7/47.3±13.7 years; 90.4%/90.4% were men Reeks2 Reeks1
10 Results Comorbidities of HIV Patients Type of Comorbidity by Age Group (HIV patients) Reeks1 Reeks2 Reeks3 Reeks4 Reeks5 Reeks6 Reeks7 Reeks8 Reeks9 7 6 Age Groups
11 Results Comorbidities (HIV vs non-hiv) Diabetes Hypertension 6 6 HIV-infected patients non-hiv-infected patients HIV-infected patients non-hiv-infected patients 6 Hypercholesterolemia HIV-infected patients non-hiv-infected patients
12 Results Comorbidities (HIV vs non-hiv) Chronic Vascular Disease Chronic Kidney Disease 6 6 HIV-infected patients non-hiv-infected patients HIV-infected patients non-hiv-infected patients Malignancy Psychiatric Disorders 6 6 HIV-infected patients non-hiv-infected patients HIV-infected patients non-hiv-infected patients
13 Results Comorbidities (Neoplasm) HIV-related cancer ICD-10 Name HIV-Infected Patients (N=116) Non-HIV Infected Patients (N=1,286) Difference n % n % Diff % (95% CL) Kaposi sarcoma % % (8.7, 21.2) Non-Hodgkin lymphoma % % 45.3% (36.1, 54.2) Cervix uteri, unspecified 2 1.7% % 0.3% (-1.2, 4.7) General cancer Bronchus or lung (C , 349) 8 6.9% % -4.5% (-8.4, 1.8) Secondary malignant neoplasm of bone and bone marrow 6 5.2% % 1.3% (-1.7, 7.0) Colon 3 2.6% % -1.9% (-4.1, 2.9) Malignant neoplasm, without specification of site 3 2.6% % (-2.5, 4.4) Secondary malignant neoplasm of brain and cerebral meninges 3 2.6% % 0.4% (-1.5, 5.2) Acute myeloblastic leukaemia [AML] 3 2.6% % (-1.4, 5.3) Multiple myeloma 3 2.6% % 1.2% (-0.7, 6.0) Breast (C ) 3 2.6% % -1.6% (-3.7, 3.2) Adult T-cell lymphoma/leukemia [HTLV-1-associated] 3 2.6% 9 0.7% 1.9% (0.1, 6.6) Stomach 2 1.7% % -8. (-10.1, -3.4)
14 Results Comorbidities (HIV vs non-hiv) HIV Polypathology (HIV-infected patients) Non-HIV Polypathology (non-hiv-infected patients) No comorbidities 1 comorbidity 2 comorbidities 3 comorbidities 4 comorbidities 5 or more comorbidities No comorbidities 1 comorbidity 2 comorbidities 3 comorbidities 4 comorbidities 5 or more comorbidities More older patients have a higher number of comorbidities.
15 Results Comorbidities (HIV vs non-hiv) HIV Polypathology (HIV-infected patients) Non-HIV Polypathology (non-hiv-infected patients) No comorbidities 1 comorbidity No comorbidities 1 comorbidity 2 comorbidities 3 comorbidities 4 comorbidities 5 or more comorbidities 2 comorbidities 3 comorbidities 4 comorbidities 5 or more comorbidities Comparable pattern between 60- to 69-year-old non-hiv patients and 40- to 49-year-old HIV patients.
16 Results Polypharmacy HIV Non-HIV Polypharmacy (HIV-infected patients) Polypharmacy (non-hiv-infected patients) No comedications 1 comedication No comedications 1 comedication 2 comedications 3 comedications 2 comedications 3 comedications 4 comedications 5 or more comedications 4 comedications 5 or more comedications More older patients take a higher number of different comedications. Fewer non-hiv patients take many comedications.
17 Results Polypharmacy Details HIV-Infected Patients Non-HIV-Infected Patients Difference (n=1,445) (n=14,450) n % n % Diff % (95%CL) Antacids, anti-flatulents, and anti-ulcerants % 2, % 16.6% (14.2, 19.2) Systemic antibacterials % % 19.6% (17.5, 21.8) Psycholeptics % 15.5% (13.4, 17.7) Systemic antihistamines % % 15.1% (13.1, 17.2) Lipid-regulating/anti-atheroma preparations % % 11.7% (9.8, 13.8) Anti-inflammatory and anti-rheumatic products % % 9.4% (7.6, 11.4) Anti-diarrheals, oral electrolyte replacers, and intestinal anti-inflammatories % % 8.3% (6.7, 10.1) Agents acting on the renin-angiotensin system % % 4.8% (3.3, 6.6) Vitamins % % (4.7, 7.9) Cough and cold preparations % % (6.1, 9.2) Calcium antagonists % % 3.8% (2.4, 5.4) Anti-gout preparations % % 5. (3.7, 6.5) Analgesics % % 4.6% (3.4, 6.1) Antithrombotic agents % % 1.1% (-0.2, 2.5) All other therapeutic products % % 3. (1.8, 4.5) Functional gastrointestinal disorder drugs % % (3.1, 5.7) Drugs used in diabetes % % 2.3% (1.2, 3.7) Cholagogues and hepatic protectors % % 3.9% (2.8, 5.3) Systemic agents for fungal infections % % 5.1% (4.1, 6.4) Anti-epileptics % % 1.1% (0.0, 2.4)
18 Conclusions Chronic comorbidities are more prevalent in HIV-infected patients compared to the same age group of non-hivinfected patients, implying that there might be a factor besides age contributing to the development of CCM in these patients HIV patients often are multidrug users, which also increases over age Chronic comorbidities and multidrug usage makes patient management and treatment challenging in HIV patients, especially in the elderly
Daniel J Ruzicka, 1 Kentaro Imai, 2 Kenichi Takahashi, 3 Toshio Naito 4. Research. Open access. Strengths and limitations of this study
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