Burden of comorbid disease, treatment, and healthcare utilization among people with HIV: A retrospective, cross-sectional study from a large healthcare organization

HIV is a chronic disease with a significant clinical and socioeconomic burden on people with HIV (PWH) and health systems.This retrospective cross-sectional study assessed the burden of HIV in Israel's Maccabi Healthcare Services in 2022.In a lookback period spanning over 2 decades with 2.6 million individuals assessed, 1973 PWH were identified, and age-and sexmatched (1:5) to 9865 randomly selected controls without HIV.We compared sociodemographic, clinical characteristics, and healthcare resource utilization (HRU; Jan-Dec 2022) between people with and without HIV; and characterized ART treatment patterns among PWH (Jan-Dec 2022).Compared to controls, PWH had a higher lifetime prevalence (since 1988; P<0.001) of several comorbid conditions, including liver disease, chronic kidney disease, any cancer, and hepatitis B and C infections.Additionally, PWH had a higher rate of anxiety and depression (26.2% vs 13.5%; P<0.001).PWH showed higher annual HRU than controls, including ~2-fold higher hospitalizations (1 new admissions; P<0.001) and frequent use of emergency, urgent, primary, specialist, and nursing care (P<0.05).Among 1907 PWH with 1 ART prescription, 78.1% had 90% coverage in 2022, though 69.1% experienced ART interruption and 7.2% discontinuation, the latter associated with mental health issues.This study recognizes critical gaps in care that could inform strategies to improve clinical outcomes and resource allocation in health systems for PWH.