Background
Advances in HIV treatment have resulted in a growing population of older (≥65 years) people living with HIV (PWH) in the U.S. However, the health profiles of this aging population have been poorly delineated. Our objective was to characterize comorbidity patterns among older adults comparing PWH to those without HIV (HIV-).
Methods
We constructed a cross-sectional cohort (2016) using a sample of older (≥65 years) Medicare beneficiaries in the U.S. Beneficiaries with HIV (n=13,080) were matched to HIV- beneficiaries (n=39,240) using propensity scores based on age, sex, race/ethnicity, state, and dual eligibility status. Latent class analysis (LCA) was used to define comorbidity profile classes using 63 comorbidities, pre-coded using the Chronic Condition Warehouse algorithm. Logistic regression was used to estimate the odds of belonging to each comorbidity profile class comparing matched HIV+ and HIV- beneficiaries.
Results
The overall cohort was predominantly male (71.9%), White (46.5%) or Black (37.0%), and had a mean age of 71.3 (SD=5.36). LCA identified five comorbidity profile classes, which we named as: Cardiometabolic (12.3% – of study cohort), Pre-Cardiometabolic (39.5%), Substance-Hepatic (8.4%), Neuro-Psychiatric (7.5%), and Minimal (32.3% – reference). Compared to the other classes, the Cardiometabolic class was characterized by a high prevalence of hypertension, ischemic heart disease, anemia, and hyperlipidemia. The Pre-Cardiometabolic class exhibited a similar profile. The Substance-Hepatic class had elevated prevalence of tobacco use and drug use disorder and viral hepatitis. The Neuro-Psychiatric class was characterized by the highest prevalence of depression, dementia, and Alzheimer’s disease. The Minimal class had the lowest prevalence of most conditions relative to the others. Beneficiaries with HIV had significantly increased odds of belonging to the Pre-Cardiometabolic (OR=1.06, 95% CI [1.01; 1.11]), Cardiometabolic (OR=1.61, 95% CI [1.51; 1.72]), and Substance-Hepatic (OR=2.43, 95% CI [2.27; 2.61) classes compared to their matched HIV- counterparts (Figure 1).
Conclusions
The findings demonstrate that older PWH (≥65 years) have specific comorbidity patterns compared to their HIV- counterparts. These results offer a valuable analytic tool for defining clinically meaningful subgroups and their associated treatments and outcomes, which may inform efforts on prevention, screening, and comprehensive management of comorbidities for older PWH in the U.S.
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