The ProjEcting Age, multimoRbidity, and poLypharmacy (PEARL) model is an agent-based simulation model of persons living with HIV (PWH) using antiretroviral therapy (ART) in the US (2009 - 2030). Due to effective treatment, PWH accessing care in the US now have a life expectancy approaching the general population. As these people survive to older ages, the burden of multimorbidity and polypharmacy will change to reflect this older age distribution and non-HIV-related healthcare costs will become increasingly important in caring for these individuals. Since the relevant results vary greatly by demographic among PWH in the US, the PEARL model accounts race, sex, HIV risk group explicitly. Among these key populations, outcomes depend further upon age, age at ART initiation, CD4 count at ART initiation, current CD4 count, and BMI. For most of its machinery, the PEARL model utilizes data from th North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD). The NA-ACCORD is comprised of data from over 20 cohorts, 200 sites, and 190,000 HIV-infected participants, providing a data set that is widely representative of HIV care in North America. Data on overall PWH population size comes mostly from CDC surveillance data. The PEARL model has been constructed to achieve the following:

Aim 1: To fill the gap in knowledge by projecting age distributions of PWH using ART in the US through 2030 broken down by key population.

Aim 2: To project the burden of multimorbidity and polypharmacy among PWH using ART in the US through 2030.

Aim 3: To project the annual costs of non-HIV-related healthcare for PWH using ART in the US through 2030.