Impact of Comorbid Illness on Persons living with HIV/AIDS
Creators: name: University Of California Office Of The President
Publisher: name: University of California Office of the President
publisherIdentifier: https://ror.org/00dmfq477
publisherIdentifierScheme: ROR
Year: 2024

description: The current model of care for HIV may not reflect the changing needs of the HIV-infected population. Complications arising from non-HIV comorbid illness are significant and increasing sources of disease for persons living HIV infection. Side effects of medication, aging of the population, and other factors have contributed towards increasing comorbid illness, including diabetes, coronary artery disease (including underlying hyperlipidemia), hypertension, chronic hepatitis C infection, osteoporosis, and psychiatric disorders. In the general population, these conditions are known to be associated with greater healthcare utilization, morbidity, and mortality. Little is known regarding trends in the occurrence of non-HIV comorbid illnesses or their impact on the care and outcomes in HIV-infected populations in the United States. Clinically, this is of great importance to California, which has the second largest number of HIV-infected residents in the U.S. On the other hand, at the policy level in California, statewide policy makers have a dramatic impact on the care of persons living with HIV-infection because of the large number of HIV-infected individuals receiving care through the public healthcare system. The current proposal is an in-depth population-based examination that will address both of these issues, as well as an evaluation of one particular aspect of caring for comorbid illness – use of specialty care. The data that will be used in the study will be a detailed research database linking established state databases to evaluate these aspects of non-HIV comorbid illness in the California Medicaid (Medi-Cal) population, a diverse population with monthly enrollment exceeding 23,000 persons. Medi-Cal pays for the majority of AIDS-related hospitalizations in California and is the single largest payer of care for HIV-infected persons in California. The Medi-Cal population can serve as a sentinel population for all HIV-infected persons in the state – understanding their care needs will inform the care needs for persons receiving care through other mechanisms. The goals of the current research proposal are to: 1. Examine the rate of non-HIV comorbid illness in persons living with HIV. 2. Explore the impact of non-HIV comorbid illness on outcomes in persons living with HIV. 3. Evaluate the use of specialty care for non-HIV comorbid illness and its on clinical outcomes – disease-specific events and mortality. Improving the quality and outcomes of persons living with HIV-infection is a dynamic process and this study will provide a framework for describing the HIV/AIDS population receiving care under public financing and identifying the most important needs based upon identified non-HIV-related illnesses that contribute towards patient outcomes. Increasing comorbidity and increasing comorbidity-related complications will have important implications for policy decisions regarding HIV care, including improving the expertise of HIV clinicians in up-to-date management of non-HIV disease, increasing access to non-HIV specialists, and expanding medication formularies to better manage non-HIV cormobid illness. Results of this study will inform such decisions and will provide a platform for further in-depth studies to expand our understanding of the quality of care delivered to HIV-infected persons in California.