Background Since HIV+ treatment has become more effective, the average age of people living with HIV (PLWHIV) has increased, and consequently the incidence of developing comorbidities, making the clinical and economic management of HIV+ patients more complex. Limited literature exists regarding the management of comorbidities costs. This study is aimed at defining and comparing the total annual costs of comorbidities, in an Italian cohort of HIV and HIV/HCV patients, from the National Healthcare Service perspective. The authors hypothesised that there are higher costs, for patients with multiple comorbidities, and a greater consumption of resources for HIV/HCV co-infected patients versus HIV mono-infected patients. Methods An observational retrospective multi-centre health-economics study, enrolling HIV+ and HIV/HCV consecutive patients with at least one comorbidity, was conducted. The consecutive cases, provided by three Italian infectious diseases centres, were related to the year 2016. The enrolled patients were on a stable antiviral therapy for at least six months. Demographic and clinical information was recorded. Costs related to HIV and HCV therapies, other treatments, medical examinations, hospitalizations and outpatient visits were evaluated. Data from mono-infected and co-infected groups of patients were compared, and the statistical analysis was performed by t-tests, chi-square and ANOVA. A sub-analysis excluding HCV therapy costs, was also conducted. The hierarchical sequential linear regression model was used to explore the determinants of costs, considering the investigated comorbidities. All analyses were conducted with a significant level of 0.05. Results A total of 676 patients, 82% male, mean age 52, were identified and divided into groups (338 mono-infected HIV+ and 338 co-infected HIV/HCV patients), comparable in terms of age, gender, and demographic characteristics. A trend towards higher annual costs, for patients with multiple comorbidities was observed in HIV mono-infected patients (respectively € 8272.18 for patients without comorbidities and € 12,532.49 for patients with three or more comorbidities, p -value: 0.001). Excluding anti-HCV therapies costs, HIV/HCV co-infected patients generally required more resources, with statistically significant differences related to cardiovascular events (€10,116.58 vs €11,004.28, p -value: 0.001), and neurocognitive impairments events (€7706.43 vs €11,641.29 p- value: < 0.001). Conclusions This study provides a differentiated and comprehensive analysis of the healthcare resources needed by HIV and HIV/HCV patients with comorbidities and may contribute to the decision process of resources allocation, in the clinical management of different HIV+ patient populations.

中文翻译：

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HIV +患者管理中的合并症和HCV合并感染：意大利临床实践的证据。

背景技术自从HIV +治疗变得更加有效以来，HIV感染者的平均年龄（PLWHIV）有所增加，并因此导致了合并症的发生，从而使HIV +患者的临床和经济管理更加复杂。关于合并症费用的管理，文献有限。这项研究的目的是从国家医疗服务部门的角度，定义和比较意大利艾滋病毒和艾滋病毒/丙肝病毒患者队列中合并症的年度总费用。作者假设，与多种感染合并症的患者相比，合并感染HIV / HCV的患者成本更高，而与HIV单一感染的患者相比，其资源消耗更大。方法一项回顾性的多中心健康经济学研究，招募了至少有一种合并症的HIV +和HIV / HCV连续患者。由意大利三个传染病中心提供的连续病例与2016年有关。入组患者接受稳定的抗病毒治疗至少六个月。记录人口和临床信息。评估了与HIV和HCV治疗，其他治疗，体检，住院和门诊就诊相关的费用。比较来自单次感染和共感染患者组的数据，并通过t检验，卡方和ANOVA进行统计分析。还进行了不包括HCV治疗费用的子分析。考虑到研究的合并症，使用分层顺序线性回归模型来探索成本的决定因素。所有分析均以0.05的显着水平进行。结果共鉴定出676名患者，其中82％为男性，平均年龄52岁，分为两组（338例单感染HIV +和338例合并感染的HIV / HCV患者），在年龄，性别和人口统计学特征方面具有可比性。在HIV单一感染患者中，观察到具有多种合并症的患者每年费用增加的趋势（无合并症的患者分别为8272.18欧元和三个或更多合并症的患者为12532.49欧元，p值：0.001）。除抗HCV治疗费用外，HIV / HCV合并感染的患者通常需要更多资源，与心血管事件（10,116.58欧元对11,004.28欧元，p值：0.001）和神经认知障碍事件（7706.43欧元对11,641.29 p-值：<0.001）。