POLYPHARMACY and comorbidity burden are significantly higher among people living with HIV across major demographic groups.
A retrospective analysis of U.S. administrative claims compared 26,078 adults living with HIV with 52,156 matched adults without HIV. Participants were matched by age group, sex, race and ethnicity, geographic region, and insurance type. Their mean age was 58.9 years, 78.7% were male, and 31.3% were Black.
The findings highlight the growing complexity of HIV care as clinicians manage antiretroviral therapy alongside multiple chronic conditions and other medications.
People living with HIV had a higher mean number of comorbidities than those without HIV, at 3.70 versus 3.14. Multimorbidity, defined as at least two non-HIV conditions, affected 66.4% and 53.7%, respectively.
Hypertension, hyperlipidemia, chronic kidney disease, and neuropsychiatric disorders were significantly more prevalent among people with HIV. Type 2 diabetes prevalence did not differ significantly overall.
Although multimorbidity increased with age, the difference was also evident among younger adults. Among participants aged 18 to 39 years, 31.1% of those with HIV had multimorbidity, compared with 18.1% of those without HIV. Prevalence among people with HIV reached 81.7% at age 70 years or older.
Women with HIV had a higher mean comorbidity burden than men with HIV, at 4.40 versus 3.33 conditions. Multimorbidity remained more common among people with HIV across White, Black, Hispanic, and Asian groups.
HIV polypharmacy, defined as the use of at least five medications excluding antiretroviral therapy, was significantly more prevalent among people with HIV across every age group.
The largest age-specific difference occurred among adults aged 40 to 49 years, with polypharmacy affecting 79.9% of people with HIV and 63.8% of matched controls. It was also more prevalent among both men with HIV, at 66.8%, and women with HIV, at 75.1%.
These findings support comprehensive comorbidity assessment and routine medication review throughout adulthood, rather than reserving this focus for older patients. Clinicians should consider the appropriateness of each medication, potential drug interactions, cumulative toxicity, and how treatment for one condition may affect another.
Interpretation is limited by the use of claims data, which cannot confirm medication use or capture nonprescription drugs. The findings may also not apply to people covered by Medicaid or traditional Medicare, or those receiving support through dedicated HIV medication programs.
Reference
Fleming SP et al. Comorbidity and polypharmacy burden among people living with HIV in the United States stratified by age, sex, and race: updated evidence from a contemporary cohort. HIV Res Clin Pract. 2026;27(1). doi:10.1080/25787489.2026.2731527.
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