Prevalence, Treatment, and Control of Dyslipidemia and Hypertension in 4278 HIV Outpatients

Myerson, Merle; Poltavskiy, Eduard; Armstrong, Ehrin J.; Kim, Shari; Sharp, Victoria; Bang, Heejung

doi:10.1097/qai.0000000000000168

Cited by 44 publications

(36 citation statements)

References 18 publications

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“…Other authors described patients with HIV‐PAH as younger than other forms of PAH, and, unlike idiopathic PAH, which is more common in women than in men (ratio of men to women 1 : 1·7), in HIV‐PAH patients the men are more frequently affected by HIV‐PAH, possibly reflecting the high prevalence of men in HIV population .…”

Section: Pulmonary Hypertension In Hivmentioning

confidence: 98%

HIV‐associated pulmonary arterial hypertension: from bedside to the future

Correale

Palmiotti

Storto

et al. 2015

Eur J Clin Investigation

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Pulmonary arterial hypertension (PAH) is a life-threatening complication of HIV infection. The prevalence of HIVassociated PAH (HIV-PAH) seems not to be changed over time, regardless of the introduction of highly active antiretroviral therapy (HAART). In comparison with the incidence of idiopathic PAH in the general population (1-2 per million), HIV-infected patients have a 2500-fold increased risk of developing PAH. HIV-PAH treatment is similar to that for all PAH conditions and includes lifestyle changes, general treatments and specific treatments.

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Section: Pulmonary Hypertension In Hivmentioning

confidence: 98%

HIV‐associated pulmonary arterial hypertension: from bedside to the future

Correale

Palmiotti

Storto

et al. 2015

Eur J Clin Investigation

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“…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 ).…”

Section: Introductionmentioning

confidence: 99%

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

Levy

Hart

et al. 2017

HIV Medicine

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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.

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“…Hypertension is common among HIV+ individuals with prevalence estimates from recent studies ranging from 19 to 52 % [33][34][35][36][37][38][39]. Some, but not all, studies have found the prevalence of hypertension to be higher among HIV+ compared with HIV− individuals.…”

Section: Hypertension In Hiv+ Individualsmentioning

confidence: 93%

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

et al. 2015

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HIV+ individuals have an increased risk for cardiovascular disease (CVD), but the mechanisms behind this association are poorly understood. While hypertension is a well-established CVD risk factor, clinic-based blood pressure (BP) assessment by itself cannot identify several important BP patterns, including white coat hypertension, masked hypertension, nighttime hypertension, and nighttime BP dipping. These BP patterns can be identified over a 24-h period by ambulatory BP monitoring (ABPM). In this review, we provide an overview of the potential value of conducting ABPM in HIV+ individuals. ABPM phenotypes associated with increased CVD risk include masked hypertension (i.e., elevated out-of-clinic BP despite non-elevated clinic BP), nighttime hypertension, and a non-dipping BP pattern (i.e., a drop in BP of <10 % from daytime to nighttime). These adverse ABPM phenotypes may be highly relevant in the setting of HIV infection, given that increased levels of inflammatory biomarkers, high psychosocial burden, high prevalence of sleep disturbance, and autonomic dysfunction have been commonly reported in HIV+ persons. Additionally, although antiretroviral therapy (ART) is associated with lower AIDS-related morbidity and CVD risk, the mitochondrial toxicity, oxidative stress, lipodystrophy, and insulin resistance associated with long-term ART use potentially lead to adverse ABPM phenotypes. Existing data on ABPM phenotypes in the setting of HIV are limited, but suggest an increased prevalence of a non-dipping BP pattern. In conclusion, identifying ABPM phenotypes may provide crucial information regarding the mechanisms underlying the excess CVD risk in HIV+ individuals.

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Prevalence, Treatment, and Control of Dyslipidemia and Hypertension in 4278 HIV Outpatients

Cited by 44 publications

References 18 publications

HIV‐associated pulmonary arterial hypertension: from bedside to the future

HIV‐associated pulmonary arterial hypertension: from bedside to the future

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

Mechanisms Influencing Circadian Blood Pressure Patterns Among Individuals with HIV

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