The Association Between the Receipt of Lipid Lowering Therapy and HIV Status Among Veterans Who Met NCEP/ATP III Criteria for the Receipt of Lipid Lowering Medication

Freiberg, Matthew S.; Leaf, David A.; Goulet, Joseph L.; Goetz, Matthew Bidwell; Oursler, Krisann K.; Gibert, Cynthia L.; Rodriguez‐Barradas, Maria C.; Butt, Adeel A.; Justice, Amy C.

doi:10.1007/s11606-008-0891-7

Cited by 44 publications

(34 citation statements)

References 35 publications

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“…Specifically, HIV infected patients were less likely to receive diuretics, ACE/ARB, beta-blockers, and antiplatelets compared to their HIV uninfected counterparts. Prior studies have suggested systematically lower use of aspirin[17, 18] and statins[19] for primary and secondary prevention in HIV patients compared to uninfected controls; however, this trend has been reversed in recent years in one integrated healthcare system, possibly due to heightened awareness of CVD risk among HIV providers[20]. Interestingly, patients who were referred to specialty cardiology care had higher treatment rates.…”

Section: Discussionmentioning

confidence: 99%

Heart failure in patients with human immunodeficiency virus infection: Epidemiology and management disparities

Al‐Kindi

ElAmm

Ginwalla

et al. 2016

International Journal of Cardiology

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Background Persons living with HIV are at a higher risk of cardiovascular disease despite effective antiretroviral therapy and dramatic reductions in AIDS-related conditions. We sought to identify the epidemiology of heart failure (HF) among persons living with HIV in the United States in an era of contemporary antiretroviral therapy. Methods Explorys is an electronic healthcare database that aggregates medical records from 23 healthcare systems nationwide. Using systemized nomenclature of medicine - clinical terms (SNOMED-CT), we identified adult patients (age > 18), who had active records over the past year (September 2014–September 2015). We described the prevalence of HF in HIV patients by demographics and treatment and compared them to HIV-uninfected controls. Results Overall, there were 36,400 patients with HIV and 12,208,430 controls. The overall prevalence of HF was 7.2% in HIV and 4.4% in controls (RR 1.66 [1.60–1.72], p<0.0001). The relative risk of HF associated with HIV infection was higher among women and younger age groups. Patients receiving antiretroviral therapy had only marginally lower risk (6.4% vs 7.7%, p<0.0001) of HF compared to those who were untreated. Compared to uninfected patients with HF, HIV patients with HF were less likely to receive antiplatelet drugs, statins, diuretics, and ACE/ARBs (p<0.0001 for all comparisons). For patients with HIV and HF, receiving care from a cardiologist was associated with higher use of antiplatelets, statins, betablockers, ACE/ARBs, and diuretics. Conclusions Persons with HIV are at higher risk for HF in this large contemporary sample that includes both men and women. Although the prevalence of heart failure is higher in older HIV patients, the relative risk associated with HIV is highest in young people and in women. HIV patients are less likely to have HF optimally treated, but cardiology referral was associated with higher treatment rates.

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Section: Discussionmentioning

confidence: 99%

Heart failure in patients with human immunodeficiency virus infection: Epidemiology and management disparities

Al‐Kindi

ElAmm

Ginwalla

et al. 2016

International Journal of Cardiology

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“…Freiberg and colleagues found that the prevalence of lipid-lowering medication among HIV-infected patients who met the National Cholesterol Education Program/Adult Treatment Panel III criteria for therapy was 39 %, compared with 62 % for uninfected patients ( p < 0.01). In multivariable analysis, HIV-infected patients were almost 60 % less likely than uninfected patients to receive indicated lipid-lowering therapy (adjusted OR = 0.43 [95 % CI 0.28, 0.67]) [100]. Aspirin for primary prevention of cardiovascular disease is also underprescribed to HIV-infected patients; in one study, only one in five patients who qualified for aspirin received it [101].…”

Section: Polypharmacy and Harmsmentioning

confidence: 99%

The Next Therapeutic Challenge in HIV: Polypharmacy

et al. 2013

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With the adoption of combination antiretroviral therapy (ART), most HIV-infected individuals in care are on five or more medications and at risk of harm from polypharmacy, a risk that likely increases with number of medications, age, and physiologic frailty. Established harms of polypharmacy include decreased medication adherence and increased serious adverse drug events, including organ system injury, hospitalization, geriatric syndromes (falls, fractures, and cognitive decline) and mortality. The literature on polypharmacy among those with HIV infection is limited, and the literature on polypharmacy among non-HIV patients requires adaptation to the special issues facing those on chronic ART. First, those aging with HIV infection often initiate ART in their 3rd or 4th decade of life and are expected to remain on ART for the rest of their lives. Second, those with HIV may be at higher risk for age-associated comorbid disease, further increasing their risk of polypharmacy. Third, those with HIV may have an enhanced susceptibility to harm from polypharmacy due to decreased organ system reserve, chronic inflammation, and ongoing immune dysfunction. Finally, because ART is life-extending, nonadherence to ART is particularly concerning. After reviewing the relevant literature, we propose an adapted framework with which to address polypharmacy among those on lifelong ART and suggest areas for future work.

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“…Despite the knowledge regarding dyslipidemia and CVD risk in HIV, some studies have shown low uptake of LLT within at-risk HIVpositive populations, with one study showing only 2% of HIV-positive patients on LLT despite a prevalence of dyslipidemia of 32.4% [105], and another large registry study showing lower uptake of LLT in HIV-positive versus HIV-negative veterans (15.4 vs 37.9%, respectively) [106].…”

Section: Assessment and Management Of Cvd Risk In Hivmentioning

confidence: 99%

Dyslipidemia, Atherosclerosis and Cardiovascular Disease: An Increasingly Important Triad in an Aging Population Living with HIV

2013

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As a result of major advances in the management of HIV over the last two decades, patients living with HIV are now encountering comorbidities commonly associated with aging. Cardiovascular disease is the leading cause of death worldwide. As the population living with HIV ages, understanding cardiovascular disease in the setting of HIV is of increasing importance. This review examines the complex interplay between cardiovascular disease, HIV infection and the drugs used to treat it, with particular emphasis on the contribution of dyslipidemia.

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The Association Between the Receipt of Lipid Lowering Therapy and HIV Status Among Veterans Who Met NCEP/ATP III Criteria for the Receipt of Lipid Lowering Medication

Cited by 44 publications

References 35 publications

Heart failure in patients with human immunodeficiency virus infection: Epidemiology and management disparities

Heart failure in patients with human immunodeficiency virus infection: Epidemiology and management disparities

The Next Therapeutic Challenge in HIV: Polypharmacy

Dyslipidemia, Atherosclerosis and Cardiovascular Disease: An Increasingly Important Triad in an Aging Population Living with HIV

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