Comorbidities and costs in HIV patients: A retrospective claims database analysis in Germany

Autoři: Stefan Christensen aff001;  Eva Wolf aff003;  Julia Altevers aff004;  Helena Diaz-Cuervo aff005
Působiště autorů: Center for Interdisciplinary Medicine (CIM) Infectious Diseases, Muenster, Germany aff001;  Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany aff002;  MUC Research, Munich, Germany aff003;  Xcenda GmbH, Hannover, Germany aff004;  Gilead Sciences Europe, Greater London, United Kingdom aff005
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224279


People living with human immunodeficiency virus (PLHIV) are at high risk of developing non-HIV related comorbidities, particularly at older ages. In a retrospective claims database analysis, we compared PLHIV to a matched, non-HIV cohort to assess the prevalence of comorbidities and healthcare costs in PLHIV and the general non-HIV population in Germany. In total, 2,132 adult patients with HIV were identified in the InGef research database with HIV ICD-10 diagnosis within each year from 2011 to 2014. Of these, 1,969 could be matched to a control cohort of 3,938 individuals (1:2 ratio). Matching criteria included age, gender and socio-economic variables. The prevalence of acute renal disease (0.5% vs. 0.2%, p = 0.045), bone fractures due to osteoporosis (6.4% vs. 2.1%, p<0.001), chronic renal disease (4.3% vs. 2.4%, p<0.001), cardiovascular disease (12.8% vs. 10.4%, p = 0.006), Hepatitis B (5.9% vs. 0.3%, p<0.001) and Hepatitis C infection (8.8% vs. 0.3%, p<0.001) was significantly higher in PLHIV compared to the matched non-HIV cohort. Mean costs excluding costs for antiretroviral therapy (ART) were significantly higher in the HIV cohort (8,049€ vs. 3,658€, p<0.05). On average, PLHIV incurred excess costs of 16,441€ for ART, 2,747€ for pharmaceuticals excluding ART (p<0.05), 1,441€ for outpatient care (p<0.05) and 321€ for inpatient care (p<0.05). Devices and remedies’ costs were significantly higher in the control cohort with excess costs of 113€ (p<0.05). Considering mean total costs, excluding ART, excess costs for PLHIV amounted to 8,049€ (p<0.05). This analysis demonstrated an increased comorbidity and economic burden of PLHIV compared to matched controls. Our findings suggest that HIV remains an area of high unmet medical need. To improve patient outcomes, adequate HIV management including regular monitoring, screening for comorbidities and optimal ART selection throughout the life course of PLHIV are of key importance.

Klíčová slova:

Age groups – Bone fracture – Cardiovascular diseases – HIV diagnosis and management – Osteoporosis – Renal diseases


1. Vogel M, Schwarze-Zander C, Wasmuth JC, Spengler U, Sauerbruch T, Rockstroh JK. The treatment of patients with HIV. Dtsch Arztebl Int. 2010;107(28–29):507–16. doi: 10.3238/arztebl.2010.0507 20703338

2. Guaraldi G, Zona S, Menozzi M, Carli F, Bagni P, Berti A, et al. Cost of noninfectious comorbidities in patients with HIV. Clinicoecon Outcomes Res. 2013;5:481–8. doi: 10.2147/CEOR.S40607 24098086

3. Bedimo R, Maalouf NM, Zhang S, Drechsler H, Tebas P. Osteoporotic fracture risk associated with cumulative exposure to tenofovir and other antiretroviral agents. AIDS. 2012;26(7):825–31. doi: 10.1097/QAD.0b013e32835192ae 22301411

4. Smit M, Brinkman K, Geerlings S, Smit C, Thyagarajan K, Sighem A, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis. 2015;15(7):810–8. doi: 10.1016/S1473-3099(15)00056-0 26070969

5. Quiros-Roldan E, Magoni M, Raffetti E, Donato F, Scarcella C, Paraninfo G, et al. The burden of chronic diseases and cost-of-care in subjects with HIV infection in a Health District of Northern Italy over a 12-year period compared to that of the general population. BMC Public Health. 2016;16(1):1146. doi: 10.1186/s12889-016-3804-4 27829390

6. Andersohn F, Walker J. Characteristics and external validity of the German Health Risk Institute (HRI) Database. Pharmacoepidemiol Drug Saf. 2016;25(1):106–9. doi: 10.1002/pds.3895 26530279

7. Kuhn J, Zirngibl A, Wildner M, Caselmann WH, Kerscher G. Regional mortality differences in Bavaria. Gesundheitswesen. 2006;68(8–9):551–6. doi: 10.1055/s-2006-926988 17039434

8. Latzitis N, Sundmacher L, Busse R. Regional differences in life expectancy in Germany at county levels and their possible determinants. Gesundheitswesen. 2011;73(4):217–28. doi: 10.1055/s-0030-1252035 20560119

9. von Gaudecker HM. Regionale Mortalitätsunterschiede in Baden-Württemberg (Regional mortality differences in Baden-Wuerttemberg) 2004 [01-24-2017]. Available from:

10. Bundesinstitut für Bau-, Stadt- und Raumforschung (BBSR; Federal Institute for Research on Building, Urban Affairs and Spatial Development). Indikatoren und Karten zur Raum- und Stadtentwicklung (INKAR; Indicators, Maps and Graphics on Spatial and Urban Monitoring) 2016 [05-12-2016]. Available from:

11. Goulet JL, Fultz SL, Rimland D, Butt A, Gibert C, Rodriguez-Barradas M, et al. Aging and infectious diseases: do patterns of comorbidity vary by HIV status, age, and HIV severity? Clin Infect Dis. 2007;45(12):1593–601. doi: 10.1086/523577 18190322

12. Friis-Moller N, Reiss P, Sabin CA, Weber R, Monforte A, El-Sadr W, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356(17):1723–35. doi: 10.1056/NEJMoa062744 17460226

13. Guaraldi G, Orlando G, Zona S, Menozzi M, Carli F, Garlassi E, et al. Premature age-related comorbidities among HIV-infected persons compared with the general population. Clin Infect Dis. 2011;53(11):1120–6. doi: 10.1093/cid/cir627 21998278

14. Luther VP, Wilkin AM. HIV infection in older adults. Clin Geriatr Med. 2007;23(3):567–83, vii. doi: 10.1016/j.cger.2007.02.004 17631234

15. Powderly WG. Non-AIDS-defining illnesses in the mature patient. The graying of an epidemic—Clinical considerations of HIV and aging. 2010;3.

16. Vance DE. Aging with HIV: clinical considerations for an emerging population. Am J Nurs. 2010;110(3):42–9. doi: 10.1097/01.NAJ.0000368952.80634.42 20179457

17. Nanni MG, Caruso R, Mitchell AJ, Meggiolaro E, Grassi L. Depression in HIV infected patients: a review. Curr Psychiatry Rep. 2015;17(1):530. doi: 10.1007/s11920-014-0530-4 25413636

18. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92(7):2506–12. doi: 10.1210/jc.2006-2190 17456578

19. Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Intern Med. 2013;173(8):614–22. doi: 10.1001/jamainternmed.2013.3728 23459863

20. Brown TT, Qaqish RB. Antiretroviral therapy and the prevalence of osteopenia and osteoporosis: a meta-analytic review. AIDS. 2006;20(17):2165–74. doi: 10.1097/QAD.0b013e32801022eb 17086056

21. Althoff KN, McGinnis KA, Wyatt CM, Freiberg MS, Gilbert C, Oursler KK, et al. Comparison of risk and age at diagnosis of myocardial infarction, end-stage renal disease, and non-AIDS-defining cancer in HIV-infected versus uninfected adults. Clin Infect Dis. 2015;60(4):627–38. doi: 10.1093/cid/ciu869 25362204

22. Ray AS, Fordyce MW, Hitchcock MJM. Tenofovir alafenamide: A novel prodrug of tenofovir for the treatment of Human Immunodeficiency Virus. Antiviral Research. 2016;125:63–70. doi: 10.1016/j.antiviral.2015.11.009 26640223

23. McComsey GA, Lupo S, Parks D, Coronado Poggio M, De Wet J, Kahl LP, et al. Switch from tenofovir disoproxil fumarate combination to dolutegravir with rilpivirine improves parameters of bone health. AIDS. 2018;32:477–85. doi: 10.1097/QAD.0000000000001725 29239893

24. Centers for Disease Control and Prevention. Behavioral and Clinical Characteristics of Persons Receiving Medical Care for HIV Infection—Medical Monitoring Project, United States, 2013 Cycle (June 2013—May 2014). HIV Surveillance Special Report 16. 2016.

25. Blackwell DL, Lucas JW, Clarke TC. Summary health statistics for U.S. adults: National Health Interview Survey, 2012. Vital Health Stat. 2014;10(260).

26. United Nations Office on Drugs and Crime. World Drug Report 2014: United Nations publication (Sales No. E.14.XI.7); 2014.

Článek vyšel v časopise


2019 Číslo 11