Psychiatric and physical comorbidities continue to be prevalent amongst Canadians living with Human Immunodeficiency Virus
1. Despite advances in treatment, a cohort of adults from British Columbia, Canda living with Human Immunodeficiency Virus (HIV) (PLWH) continued to experience a higher burden of many physical and mental comorbidities.
Evidence Rating Level: 2 (Good)
Over the past several decades, HIV care has improved drastically; however, comorbidities in people living with HIV (PLWH) have started to burden the healthcare system. These comorbidities often develop at younger ages and with greater severity than in people without HIV (PnLWH). This increased burden is driven by factors such as chronic inflammation, antiretroviral therapy (ART) side effects, and lifestyle factors, among others. This retrospective cohort study aimed to compare trends in physical and mental comorbidities and their related healthcare costs between PLWH and PnLWH. There were 16 physical and mental comorbidities assessed, including major chronic conditions (e.g. cardiovascular disease, diabetes, chronic kidney disease, chronic liver disease, and non-AIDS-defining cancers), neurocognitive disorders, musculoskeletal diseases, and mental health conditions (e.g. mood/anxiety, schizophrenia, personality disorders, and substance use disorder). The study included 9,554 PLWH and 47,770 PnLWH matched based on study criteria. Throughout the study period, PLWH consistently had a higher prevalence of comorbidities even after adjusting for age and sex. Among PLWH, mood disorders were the most prevalent comorbidities, affecting 40% of individuals, compared to 24% in PnLWH. Mental health disorders and substance use disorder (SUD) consistently affected PLWH more than PnLWH. In 2007, PLWH were over 8 times more likely to develop chronic liver disease (CLD) compared to PnLWH (PR=8.30, 95% CI: 6.33 to 10.98). Similarly, in 2008, chronic kidney disease (CKD) was about 6 times more likely to occur in PLWH compared to PnLWH (PR in 2008=6.07, 95% CI: 4.83 to 7.66). The gap in both conditions has narrowed over time, mainly because conditions became less common in PLWH and more common in PnLWH. Healthcare costs were significantly higher in PLWH compared with PnLWH. Despite advances in treatment, PLWH continue to face a higher and evolving burden of comorbidities, particularly mental health disorders and substance use disorder, significantly impacting the healthcare system. This emphasizes the need for comprehensive and integrated care models to better support the complex health needs of PLWH.
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