OBJECTIVES : Improved survivorship in persons living with HIV translates into higher risk of acquiring medical comorbidities. We assessed the association between intersection of physical (HIV diagnosis) and mental health (psychiatric conditions) and intermediate outcomes.

METHODS : Cross-sectional study using Medical Expenditure Panel Survey (MEPS)-Household Component consisting of nationally representative U.S. civilian non-institutionalized population. Using data between 1996 and 2016, we created four groups for persons aged ≥18: (1) HIV + psychiatric comorbidity, (2) HIV, (3) psychiatric comorbidity, and (4) no-HIV, no-psychiatric comorbidity. We compared the burden of medical comorbidities (metabolic disorders, cardiovascular disease, cancers, infectious diseases, pain, and substance use) across the groups using chi square tests. We used logistic regression to determine the association between group status and medical comorbidity.

RESULTS : We identified 218,133,630 (weighted) persons aged ≥18, of which 0.18% were HIV positive. Forty-three percent of HIV group and 19% of no-HIV group had psychiatric comorbidities. Half of the HIV+ psychiatric disorder group had at least one medical comorbidity, pain being the most frequent (23%). Compared to the no-HIV, no-psychiatric comorbidity group, the HIV + psychiatric comorbidity group had highest odds of having any medical comorbidity (OR= 3.69, 95% CI = 2.99, 4.52), and all six individual medical comorbidities.

CONCLUSIONS : We observed higher risk of medical comorbidities of pain, cancer, cardiovascular disease, substance use, metabolic disorders and infectious diseases in patients presenting with HIV + psychiatric comorbidity, beyond that experienced by persons with HIV infection or psychiatric disorders, independently. Future research must focus on the mediating effects of social determinants of health and biological factors on quality of life, cost and mortality, for developing community and clinical level interventions. A shift away from the single-disease framework and coordinated care strategies can compress morbidity among the aging cohort of HIV infected persons.