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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