Impact of Comorbid Illness on Persons Living with HIV/AIDS

David Zingmond, UC-Los Angeles
HIV/AIDS Policy & Health Care Financing

Background: 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 with HIV infection. Side effects of medication, aging of the population and other factors have contributed towards increasing comorbid illness (e. g. diabetes, coronary artery disease, hypertension, 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 or impact of non-HIV comorbid illnesses on care and outcomes in HIV-infected populations in the U. S.This is clinically important to California, which has the second largest number of HIV-infected persons in the U. S., and also at the policy level because of the large number of HIV-infected individuals receiving care through the public healthcare system. This research will address both of these issues, as well as an evaluation of one particular aspect of caring for comorbid illness - use of specialty care. This research will: (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, and (3.) evaluate the use of specialty care for non-HIV comorbid illness and its clinical outcomes - disease-specific events and mortality.

Methods: The data to 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 Califor-nia. 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.

Results: We will identify rates of non-HIV comorbid illness in HIV-infected Medi-Cal enrollees, the impact of these diseases on patient outcomes and the effect of access to care non-HIV generalist and specialty care on disease-specific events and outcomes.

Conclusions: 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. Results of this study will inform clinical and policy 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.