Healthcare Resources Use in Patients with Human Immunodeficiency Virus (HIV). Real-World Evidence From Six Italian Local Health Units

Valentina Perrone, Diego Sangiorgi, Stefano Buda, Margherita Andretta, Silvio Borrè, Chiara Cattaruzzi, Gina Gasperini, Fabio Lena, Alessia Pisterna, Luca Degli Esposti



AIM: The aim of the study was to evaluate healthcare resource use and related costs for the management of people living with Human Immunodeficiency Virus (PLWHIV) with and without comorbidities, and to compare the burden of comorbidities in PLWHIV to the general population.
METHODS: An observational retrospective analysis, based on administrative and laboratory databases from 6 Italian Local Health Units (LHUs) was performed. Individuals receiving either an HIV treatment [Antiretroviral therapy (ART) – ATC code: J05A)], or with an HIV positive laboratory test result between January 1st, 2014 and December 31st, 2014 were included. The date of first ART prescription or positive test of HIV was used as the Index Date (ID). Patients enrolled were followed-up for all time available from the ID (follow-up period) and their clinical characteristics were investigated from one year prior to the ID (characterization period). Comorbidities were measured by using the Charlson Comorbidity Index; findings were compared with those of a sample of the general population with the same age and sex distribution (OsMed 2015). Healthcare resource use and related cost was evaluated during the follow-up period.
RESULTS: 1,214 patients were included, 837 were PLWHIV without any comorbidities and 377 were PLWHIV with at least one comorbidity. Mean prevalence of prescriptions for treatment of comorbidities was higher in the HIV-infected population than in the Italian general population. The annual healthcare cost of managing HIV patients with comorbidities, was significantly higher than that for patients without comorbidities (€ 10,615 vs. € 8,665, p < 0.001).
CONCLUSIONS: Study results showed that 30% of PLWHIV had at least one comorbidity. The cost of managing PLWHIV who have comorbidities was significantly higher than that of managing PLWHIV without comorbidities. Our data confirm that care and treatment services should be adapted to address the specific needs of people living with both HIV and comorbidities.


Human Immunodeficiency Virus (HIV); Antiretroviral therapy (ART): Healthcare resource use; Costs; Comorbidities; Real-world evidence

Full Text



  • Smit M, Brinkman K, Geerlings S, et al. Future challenges for clinical care of an ageing population infected with HIV: a modelling study. Lancet Infect Dis 2015; 15: 810-8;
  • Mahy M, Autenrieth CS, Stanecki K, et al. Increasing trends in HIV prevalence among people aged 50 years and older: evidence from estimates and survey data. AIDS 2014; 28: S453-9;
  • Van Sighem A, Gras L, Reiss P, et al. Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS 2010; 24: 1527-35;
  • Nakagawa F, Lodwick RK, Smith CJ, et al. Projected life expectancy of people with HIV according to timing of diagnosis. AIDS 2012; 26: 335-43;
  • Nakagawa F, May M, Phillips A. Life expectancy living with HIV: recent estimates and future implications. Curr Opin Infect Dis 2013; 26: 17-25;
  • Guaraldi G, Malagoli A, Calcagno A, et al. The increasing burden and complexity of multi-morbidity and polypharmacy in geriatric HIV patients: a cross sectional study of people aged 65 - 74 years and more than 75 years. BMC Geriatr 2018; 18: 99;
  • Foglia E, Maggiolo F, Quirino T, et al. Multiple Pill Regimens, Single Tablet Regimens and Hiv+ Patients Quality of Life: Evidence from the Straq Study. Value Health 2015; 18: A591;
  • Venturini A, Cenderello G, Di Biagio A, et al. Quality of life in an Italian cohort of people living with HIV in the era of combined antiretroviral therapy (Evidence from I.A.N.U.A. study-investigation on antiretroviral therapy). AIDS Care 2017; 29: 1373-7;
  • Mpondo BCT. HIV Infection in the Elderly: Arising Challenges. J Aging Res 2016; 2016: 1-10;
  • De Socio GV, Ricci E, Maggi P, et al. Time trend in hypertension prevalence, awareness, treatment, and control in a contemporary cohort of HIV-infected patients: the HIV and Hypertension Study. J Hypertens 2017; 35: 409-16;
  • Bandera A, Gori A, Sabbatini F, et al. Evaluation of the Prognostic Value of Impaired Renal Function on Clinical Progression in a Large Cohort of HIV-Infected People Seen for Care in Italy. PLoS One 2015; 10: e0124252;
  • Borderi M1, Calza L, Colangeli V, et al. Prevalence of sub-clinical vertebral fractures in HIV-infected patients. New Microbiol 2014; 37: 25-32
  • Gebo KA, Fleishman JA, Conviser R, et al. Contemporary costs of HIV healthcare in the HAART era. AIDS 2010; 24: 2705-15;
  • Guaraldi G, Zona S, Menozzi M, et al. Cost of noninfectious comorbidities in patients with HIV. Clinicoecon Outcomes Res 2013; 5: 481-8;
  • Perrone V, Saragoni S, Buda S, et al. Pharmacoutilization of epoetins in naive patients with hematological malignancies in an unselected Italian population under clinical practice setting: a comparative analysis between originator and biosimiliars. Biol Targets Ther 2016; 10: 157-65;
  • Agenzia Italiana del Farmaco (AIFA). Guideline for the classification and conduction of the observational studies on medicines. 2010. Available at (last accessed June 2018)
  • Centers for Disease Control and Prevention. Atrial Fibrillation Fact Sheet. Centers for Disease Control and Prevention Website. Available at (last accessed June 2018)
  • Agenzia Italiana del Farmaco (AIFA). L’uso dei farmaci in Italia—rapporto OsMed 2015. Available at (last accessed June 2018)
  • Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373-83
  • Lorenc A, Ananthavarathan P, Lorigan J, et al. The prevalence of comorbidities among people living with HIV in Brent: a diverse London Borough. Lond J Prim Care 2014; 6: 84-90
  • Rodriguez-Penney AT, Iudicello JE, Riggs PK, et al. Co-Morbidities in Persons Infected with HIV: Increased Burden with Older Age and Negative Effects on Health-Related Quality of Life. AIDS Patient Care STDs 2013; 27: 5-16;
  • AIDS info. Considerations for Antiretroviral Use in Special Patient Populations HIV and the Older Patient. Available at (last accessed June 2018)
  • Goulet JL, Fultz SL, Rimland D, et al. Do Patterns of Comorbidity Vary by HIV Status, Age, and HIV Severity? Clin Infect Dis 2007; 45: 1593-601;
  • Wu P-Y, Chen M-Y, Hsieh S-M, et al. Comorbidities among the HIV-Infected Patients Aged 40 Years or Older in Taiwan. Huang L-M, editor. PLoS ONE 2014; 9: e104945;
  • Ranzani A, Oreni L, Agrò M, et al. Burden of Exposure to Potential Interactions Between Antiretroviral and Non-Antiretroviral Medications in a Population of HIV-Positive Patients Aged 50 Years or Older. J Acquir Immune Defic Syndr 2018; 78: 193-201;
  • Ssonko M, Stanaway F, Mayanja HK, et al. Polypharmacy among HIV positive older adults on anti-retroviral therapy attending an urban clinic in Uganda. BMC Geriatr 2018; 18: 125;
  • Caro-Vega Y, Belaunzarán-Zamudio PF, Crabtree-Ramírez B, et al. Trends in proportion of older HIV-infected people in care in Latin America and the Caribbean: a growing challenge. Epidemiol Infect 2018: 1-4;
  • Nachega JB, Hsu AJ, Uthman OA, et al. Antiretroviral therapy adherence and drug–drug interactions in the aging HIV population. AIDS 2012; 26: S39-53;
  • Tseng A, Szadkowski L, Walmsley S, et al. Association of Age With Polypharmacy and Risk of Drug Interactions With Antiretroviral Medications in HIV-Positive Patients. Ann Pharmacother 2013; 47: 1429-39;
  • Capeau J. Premature Aging and Premature Age-Related Comorbidities in HIV-Infected Patients: Facts and Hypotheses. Clin Infect Dis 2011; 53: 1127-9;
  • Smit M, Cassidy R, Cozzi-Lepri A, et al. Quantifying the future clinical burden of an ageing HIV-positive population in Italy: a mathematical modelling study. Geneva: International AIDS Society, 2016
  • Girardi E, D’arminio Monforte A, Camoni L, et al. Curare la malattia da HIV: ritorno al paziente? Recenti Prog Med 2016; 107: 525-50
  • Quiros-Roldan E, Magoni M, Raffetti E, 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: 1146;


Abstract: 916 views
HTML: 386 views
PDF: 241 views


  • There are currently no refbacks.

© SEEd srl