20th International AIDS Conference - Melbourne, Australia

Abstract

THPE035 - Poster Exhibition


HIV patient care expertise - an aging population necessitates new skill sets: managing CVD risk

N.L. Okeke, T. Chin, M.E. Clement, C.B. Hicks

Duke University Medical Center, Medicine - Infectious Diseases, Durham, United States

Background: Persons living with HIV (PLWHI) have increased cardiovascular disease (CVD) risk and require careful longitudinal CVD risk factor management. How well this is accomplished in HIV specialty clinics was assessed in a retrospective cohort study comparing management of hypertension and dyslipidemia in PLWHI to care provided to a contemporaneous cohort of demographically-matched HIV-uninfected patients.
Methods: Data from HIV-infected persons age ≥ 40 cared for in the Duke HIV Clinic for > one year were compared to a demographically similar age, sex and race-matched HIV-uninfected control population followed in a Duke-affiliated primary care clinic. Patients with prior MI or CVA were excluded, as were data from HIV-infected persons receiving primary care outside the Duke HIV Clinic.. Data collected included the most recent BP readings (n=5) and lipid profiles (n=3), and each patient''s CVD-related medications. Management of hypertension and hyperlipidemia were compared to JNC VII and NCEP ATP III standards, respectively. Comparisons were done using Χ2 tests for categorical variable/proportions and unpaired t-tests for continuous variables.
Results: 890 HIV-infected persons (male 77.3%, median age 50 yrs, mean CD4 552 cells/mL, HIV VL < 400 copies/mL 64.1%) were compared to 807 matched HIV-uninfected persons. The median Framingham 10yr risk score was 4% for both cohorts. Uncontrolled hypertension was equally common in both groups (HIV+ 17.6% v. HIV- 19.1%). However, among persons with hypertension fewer HIV-infected persons (57.7%) were prescribed anti-hypertensives than HIV-uninfected persons (75.0%; p = 0.001). Hyperlipidemia was more common in HIV-uninfected persons (HIV+ 18.1% vs. HIV- 26.4%, p < 0.001). Among those with hyperlipidemia, fewer HIV-infected persons (25%) were prescribed statins than HIV-uninfected persons (42.3%; p < 0.001). Despite similar CVD risk profiles of both groups, aspirin (11.5% v. 22.8%, p < 0.001), statins (15.1% v. 23.6%) and anti-hypertensives (35.6 v. 52.0%, p < 0.001) were prescribed less often in HIV-infected persons.
Conclusions: Appropriate CVD risk factor management in HIV-infected persons with uncontrolled hypertension and hyperlipidemia occurred less often than in a demographically-matched cohort of HIV-uninfected persons, indicating a need for improved CVD risk assessment and management in the HIV specialty clinic.

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