High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC

Abstract

Objectives With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. Methods Utilizing an electronic medical record (EMR) database from the DC Cohort – a multi-center prospective cohort study of HIV outpatients – we assessed the period prevalence of metabolic comorbidities between 2011–2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. Results Of 7,018 adult patients (median age 50 years; 77% black), 50% (95% CI: 49–51) had hypertension, 13% (95% CI: 12–14) had diabetes, 48% (95% CI: 47–49) had dyslipidemia, and 35% (95% CI: 34–36) had obesity. Hypertension was more prevalent among blacks, diabetes and obesity were more prevalent among females and blacks, dyslipidemia was more prevalent among males and whites, and comorbidities were more prevalent among older patients (all p<0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immuno-virological parameters were associated with metabolic comorbidities. Conclusions These findings underscore the pervasive burden of metabolic comorbidities among HIV-infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population.

Aging and the evolution of comorbidities among HIV-positive individuals in a European cohort

“…We also observed high prevalence of dyslipidaemia, based on total and HDL cholesterol and triglyceride levels, in 2006 and 2014. This is comparable to several studies in the USA which reported dyslipidaemia in 58-80% of participants [32][33][34]. Some of this variation may be explained by different definitions, e.g.…”

“…whether triglyceride levels are included or whether lipid levels are based on fasting blood samples. The low prevalence of obesity was similar to data reported for the AgehIV [31] and the Swiss cohort [10], although considerably lower than seen in cohorts of PLWHIV in the USA [32][33][34][35], probably due to life-style factors and different demographics since the European cohorts are dominated by MSM.…”

“…In this study, the prevalence of hypertension increased between 2006 and 2014, and was somewhat higher than previously reported [29,30], possibly due to the older age of those included here. More recent studies report a higher burden of hypertension compared to uninfected populations [10,[31][32][33]. We also observed high prevalence of dyslipidaemia, based on total and HDL cholesterol and triglyceride levels, in 2006 and 2014.…”

Patterns of comorbidity and sociodemographic and psychosocial correlates among people living with HIV in South Carolina, USA

“…Also, PLWH who were older, did not have a full‐time job and had been living with HIV infection for a longer time were more likely to have chronic comorbid conditions. Metabolic comorbidities were more prevalent among older patients , and this result is consistent with previous findings . These results signify that tailored intervention efforts are needed for populations with different traits in terms of relevant comorbidity patterns.…”

Construção e validação de material educativo digital para redução do risco cardiovascular em pessoas vivendo com HIV

“…Además, el material está disponible gratuitamente para descargar en Apple books ® y en Google play ® pudiendo alcanzar ampliamente a las personas que viven con VIH de todo Brasil. Descriptores: Infecciones por VIH; Enfermedades Cardiovasculares; Educación en Salud; Tecnología Educacional; Enfermería. LITERATURA....................................................... CRAWFORD; STEIN, 2014;NTSUI;NTSEKHE, 2016;LEVY et al, 2017;REINSCH et al, 2017;ECHECOPAR-SABOGAL et al, 2018;HATLEBERG et al, 2018) TRIANT, 2013;PAULA et al, 2014;TRØSEID et al, 2014;XIMENES et al, 2015;GUTIERREZ;ALBUQUERQUE;FALZON, 2017;HALDANE et al, 2018;HATLEBERG et al, 2018;SHAH et al, 2018;ALVI et al, 2019;TEER et al, 2019). Assim, a promoção de um ambiente informativo, reduz ansiedades quanto à sua condição e tratamento, capacita para tomada de decisão, motiva para comportamentos positivos e gera a possibilidade de criação de redes, permitindo a troca de informações entre pacientes e profissionais, sendo estes exemplos de aplicações das estratégias que utilizam tecnologia pertinentes à promoção da saúde e educação do paciente (RICHARD; STREET JR, 1997;GUSTAFSON et al, 2002).…”