Low-Density Lipoprotein Cholesterol Levels and Statin Treatment by HIV Status Among Multicenter AIDS Cohort Study Men

Abstract

Treating cardiovascular disease (CVD) risk factors, including dyslipidemia, is important in HIV care. Low-density lipoprotein cholesterol (LDL-c) target achievement is a readily available benchmark for dyslipidemia control, although use of this target is not uniformly endorsed by professional societies. We examined whether HIV serostatus is associated with not achieving LDL-c target. Among Multicenter AIDS Cohort Study (MACS) participants completing visit 56 (10/1/2011-3/31/2012), we categorized each man as on or off statin therapy and used NCEP ATP III guidelines to determine if each man was at LDL-c target or not at target. We compared proportions of men not at target and determined predictors using multivariate logistic regression. Sixty of 543 (11.1%) HIV-infected men and 87 of 585 (14.9%) HIV-uninfected men not receiving statin therapy were not at target (p=0.07), while 31 of 230 (13.5%) HIV-infected and 29 of 204 (14.2%) HIV-uninfected men receiving statin therapy were not at target (p=0.82). Factors associated with not being at target (among men not receiving statin therapy) included current smoking (OR=2.31, 95% CI 1.31, 4.06) and a diagnosis of hypertension (OR=4.69, 95% CI 2.68, 8.21). Factors associated with not being at target (among men receiving statin therapy) included current smoking (OR=2.72, 95% CI 1.30, 5.67) and diabetes (OR=5.31, 95% CI 2.47, 11.42). HIV-infected and HIV-uninfected men receiving statin therapy demonstrated similar nonachievement of LDL-c targets. Comorbidities (e.g., diabetes) lowered targets and may explain why goals were less likely to be met.

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

“…The period prevalence estimates obtained for the sample of adult HIV‐infected patients in the DC Cohort are generalizable to the broader HIV‐infected outpatient population in a large urban US city. Half of HIV‐infected patients in the DC Cohort were classified as hypertensive, which represents a higher prevalence compared with the 32% of participants in the EuroSIDA study , 14% of participants in the D:A:D study , 45% of participants in the Swiss HIV Cohort Study , 32% of male patients in the VACS‐VC , 32% of female patients in the WIHS , 43% of HIV‐infected outpatients at an urban New York health centre , and 44% of male patients in the MACS with hypertension , although it also represents a marginally lower prevalence compared with the 54% of male patients and 57% of female patients in the HOPS with hypertension . Among DC Cohort patients, 12% of male patients and 16% of female patients had diabetes, which was comparable to the 12% of male patients and 19% of female patients in the HOPS , 13% of male patients in the MACS , 14% of male patients in the VACS‐VC , and 18% of female patients in the WIHS with diabetes , but higher than the 5% of participants in the EuroSIDA study , 3% in the D:A:D study , and 7% in the Swiss HIV Cohort Study with diabetes .…”

“…Half of HIV‐infected patients in the DC Cohort were classified as hypertensive, which represents a higher prevalence compared with the 32% of participants in the EuroSIDA study , 14% of participants in the D:A:D study , 45% of participants in the Swiss HIV Cohort Study , 32% of male patients in the VACS‐VC , 32% of female patients in the WIHS , 43% of HIV‐infected outpatients at an urban New York health centre , and 44% of male patients in the MACS with hypertension , although it also represents a marginally lower prevalence compared with the 54% of male patients and 57% of female patients in the HOPS with hypertension . Among DC Cohort patients, 12% of male patients and 16% of female patients had diabetes, which was comparable to the 12% of male patients and 19% of female patients in the HOPS , 13% of male patients in the MACS , 14% of male patients in the VACS‐VC , and 18% of female patients in the WIHS with diabetes , but higher than the 5% of participants in the EuroSIDA study , 3% in the D:A:D study , and 7% in the Swiss HIV Cohort Study with diabetes . More than half of male patients and more than 40% of female patients in the DC Cohort were classified as dyslipidaemic, and these prevalences are higher than the 37% of male patients and 31% of female patients at an urban New York health centre , 45% of EuroSIDA study participants , and 42% of D:A:D study participants with dyslipidaemia , but lower than the 58% of male patients in the VACS‐VC , 81% of male patients and 67% of female patients in the HOPS , and 92% of male patients in a MACS substudy with dyslipidaemia ; these large differences might be attributed to different histories of ARV therapy and/or the use of different quantitative cut‐offs for various lipid parameters to define dyslipidaemia.…”

“…Metabolic comorbidities among HIV‐infected persons have been examined in other large observational cohort studies including the EuroSIDA study , Data Collection on Adverse Events of Anti‐HIV Drugs (D:A:D) study , Swiss HIV Cohort Study , HIV Outpatient Study (HOPS) , Veterans Aging Cohort Study (VACS) and its Virtual Cohort (VACS‐VC) , Multicenter AIDS Cohort Study (MACS) , Women's Interagency HIV Study (WIHS) , North American AIDS Cohort Collaboration on Research and Design (NA‐ACCORD) , and an electronic medical record (EMR) study at a health care centre in New York City . Despite recent publications, however, robust prevalence estimates based on recent data are largely unavailable: data collection for the aforementioned studies occurred mostly prior to 2010, metabolic variables were often reported as baseline covariates in longitudinal analyses or in smaller substudies focused on other health outcomes, and restrictive analytic inclusion/exclusion criteria have sometimes resulted in study samples that were not representative of the larger population of HIV‐infected patients (Table ).…”

Underutilization of Statins for Prevention of Cardiovascular Disease among Primarily African-American HIV-Infected Patients

“…The association of hepatitis C and statin use is important in light of our earlier study which demonstrated that chronic hepatitis C infection was associated with higher CHD risk [unpublished data]. A recent data analysis from the Multicenter AIDS Cohort Study (MACS) showed elevated transaminase levels were associated with not achieving LDL-c targets suggesting a reluctance of providers to initiate statins which are potentially hepatotoxic [33]. This may explain the underutilization of statins among HIV-hepatitis C co-infected patients.…”

“…The differences in findings may be due to differences in patient and provider study populations [34]. In the HIV Outpatient Study (HOPS) and MACS analyses, however, current smoking was associated with lesser achievement of target LDL-c goals which may be explained by lower LDL-c targets due to presence of this risk factor that require more aggressive lipid-lowering therapy [26,33]. These observations are important because of the higher prevalence and risk of MI attributed to smoking in the HIV population compared to the general population [8].…”