Costs, Therapies Associated With Treating HIV Complications

In part two of this podcast series, Daniel Lee, MD, clinical director, Pacific AIDS Education Training Center HIV Learning Network, and director, Owen Lipid/Lipodystrophy Clinic, University of California–San Diego, discusses the therapies used to treat HIV-related complications and the financial burden associated with treatment.

Listen to part one.

Welcome back to Pop Health Perspectives, a conversation with the Population Health Learning Network where we combine expert commentary, and exclusive insight into key issues in population health management and more. Today we are joined by Dr Daniel Lee, clinical director of the Pacific Aids Education Training Center HIV Learning Network, and director of the Owen Lipid/Lipodystrophy Clinic at the University of California, San Diego. In the second part of this podcast series, he offers insight on the therapies used to treat HIV related complications, and the financial burden associated with treatment. Dr Lee?

Hi, I'm Daniel Lee. I'm a clinical professor of medicine at UC San Diego Health. I work as a primary care HIV physician at the Owen Clinic, which is our HIV clinic at UCSD Medical Center. My area of specialty, I'm an internist by trade, but specialize in HIV care, and my research is focused on the clinical management of metabolic complications in HIV. I started a sub-specialty lipid lipodystrophy clinic about 20 years ago to address these particular issues.

When it comes to treating HIV related complications, what drugs or therapies do you typically find yourself using, and what factors contribute to how successful or ineffective these therapies are?

Well, if we first talk about the lipid abnormalities, the treatment that we use are the typical ones. Things like statins and fibrates which work just as well in the HIV population as in the non-HIV population. A challenge that we have is the acceptability of statins is not always high due to people's concern about the well publicized side effects of statins, especially the muscle aches, potential liver toxicity. We don't see it that often, but it still is a concern for many of our patients. We also may use other things like fish oil as well, which may help with lowering triglycerides too, and in some patients, they prefer more natural medications and sometimes fish oil is perceived that way.

That is sometimes used as well. In terms of the treatment of glucose abnormalities, we oftentimes use the same medications that we use for the non-HIV population. That includes things like metformin, but these days we are using a lot of the newer classes of medications, such as GLP-1 receptor agonists, SGLT2 inhibitors as well as DPP-4 inhibitors. In part, this is because many of these agents also help with weight loss, and that is many times desirable in people who are diabetic or are gaining weight. For the treatment of lipodystrophy and HIV wasting we can use growth hormone products.

For lipodystrophy we use growth hormone releasing factor, for the treatment of HIV wasting, we use growth hormone. The success of these treatments oftentimes depends on the adherence to all of these medications, in addition to the non-pharmacologic treatments such as improving diet and exercise.

To pivot more towards costs, can you comment on the financial burden associated with HIV complications?

As people live with HIV longer and grow older, I anticipate that we will continue to see more of these HIV associated complications. As a result, the financial burden associated with these comorbidities will also increase. I think it's quite clear that as you diagnose more of these comorbidities, that then leads to more prescriptions and polypharmacy.

This will also lead to more clinic visits to have to deal with adjustments to medications, starting-stopping medications, evaluating for side effects. The downstream complications related to these comorbidities can lead to hospitalization, especially if we're seeing things like heart attacks and strokes, thus increasing the entire financial burden. Unfortunately, it comes with living longer, the higher financial costs.

Is there anything else you wanted to add today?

No, but thank you for the opportunity to share my knowledge with your audience.

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