Treatment and comorbidity burden among people living with HIV: a review of systematic literature reviews

Abstract

Background: As the human immunodeficiency virus (HIV) treatment landscape continues to evolve, the prolonged life expectancy and long-term exposure to antiretroviral drugs have modified the burden associated with living with HIV.

Objective: To better understand the current treatment and comorbidity burden in people living with HIV (PLWH).

Methods: Peer-reviewed systematic literature reviews (SLRs) between 2017 and 2020 that included US studies and examined drug adherence/pill burden, resistance burden, or comorbidities in PLWH were identified. Methods and findings were extracted for the overall studies and examined in the subset of US studies.

Results: Among 665 publications identified, 47 met the inclusion criteria (drug adherence/pill burden: 5; resistance: 3; comorbidities: 40). While antiretroviral drug adherence levels varied across SLRs, single-tablet regimens (STR) were associated with higher adherence versus multiple-tablet regimens. STRs were also associated with lower risk of treatment discontinuation, higher cost-effectiveness, and lower risk of hospitalization. Longer survival resulted in a high comorbidity burden, with non-AIDS causes accounting for 47% of deaths among PLWH in the US. HIV doubled the risk of cardiovascular disease and was associated with other health problems, including bone and muscle diseases, depression, and cancers. Several antiretroviral regimens were associated with chronic diseases, including cardiometabolic conditions. Lifetime HIV costs are substantially increasing, driven by antiretroviral, adverse event, and comorbidity treatment costs cumulated due to longer survival times.

Conclusions: There is a considerable burden associated with HIV and antiretroviral treatment, highlighting the benefits of less complex and safer regimens, and the unmet need for effective preventative interventions.

Keywords: Adherence; antiretrovirals; comorbidities; human immunodeficiency virus; treatment resistance.

Figure 1.

PRISMA diagram of study selection. Abbreviations: ART, antiretroviral therapy; HIV, human immunodeficiency virus; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-analysis; SLR, systematic literature review. US, United States. ^aSLRs that included both non-US and US studies, with results at the study level presented (for the US studies), were not excluded. ^bSLRs where the country was not specified overall or at the study level were excluded. ^cOne scoping review included a US study in children aged 7–17 years. It was manually added to include potentially relevant information, despite the study population including children less than 9 years of age.

Figure 2.

Main findings related to HIV ART adherence and pill burden, antiretroviral resistance burden, and comorbidity burden. Abbreviations: AE, adverse event; AIDS, acquired immunodeficiency syndrome; ART, antiretroviral therapy; CVD, cardiovascular disease; HCV, hepatitis C virus; HIV, human immunodeficiency virus; MTR, multiple-tablet regimen; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PI, protease inhibitor; PLWH, people living with HIV; STR, single-tablet regimen.