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Courlet P, Livio F, Alves Saldanha S, Scherrer A, Battegay M, Cavassini M, Stoeckle M, Decosterd LA, Marzolini C. Real-life management of drug-drug interactions between antiretrovirals and statins. J Antimicrob Chemother 2021; 75:1972-1980. [PMID: 32240298 DOI: 10.1093/jac/dkaa099] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/21/2020] [Accepted: 02/22/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND PIs cause drug-drug interactions (DDIs) with most statins due to inhibition of drug-metabolizing enzymes and/or the hepatic uptake transporter OATP1B1, which may alter the pharmacodynamic (PD) effect of statins. OBJECTIVES To assess the management of DDIs between antiretrovirals (ARVs) and statins in people living with HIV (PLWH) considering statin plasma concentrations, compliance with dosing recommendations and achievement of lipid targets. METHODS PLWH of the Swiss HIV Cohort Study were eligible if they received a statin concomitantly with ARVs. HDL, total cholesterol (TC) and statin plasma concentration were measured during follow-up visits. Individual non-HDL and TC target values were set using the Framingham score and the 2018 European AIDS Clinical Society recommendations. RESULTS Data were analysed for rosuvastatin (n = 99), atorvastatin (n = 92), pravastatin (n = 46) and pitavastatin (n = 21). Rosuvastatin and atorvastatin underdosing frequently led to suboptimal PD response. Insufficient lipid control was observed with PIs despite high atorvastatin concentrations, likely explained by inhibition of OATP1B1 resulting in less statin uptake in the liver. Target lipid values were more often achieved with unboosted integrase inhibitors due to both their favourable DDI profiles and neutral effect on lipids. Insufficient lipid control was common with pravastatin and pitavastatin regardless of co-administered ARVs and despite using maximal recommended statin doses. The latter suggests lower efficacy compared with rosuvastatin or atorvastatin. CONCLUSIONS Suboptimal management of DDIs with statin underdosing was observed in 29% of prescriptions. Integrase inhibitor-based regimens and/or treatment with rosuvastatin or atorvastatin should be favoured in patients with refractory dyslipidaemia.
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Affiliation(s)
- Perrine Courlet
- Service of Clinical Pharmacology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Françoise Livio
- Service of Clinical Pharmacology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Susana Alves Saldanha
- Service of Clinical Pharmacology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Alexandra Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.,Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Manuel Battegay
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Matthias Cavassini
- Service of Infectious Diseases, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Marcel Stoeckle
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland
| | - Laurent Arthur Decosterd
- Service of Clinical Pharmacology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Catia Marzolini
- University of Basel, Basel, Switzerland.,Division of Infectious Diseases and Hospital Epidemiology, Departments of Medicine and Clinical Research, University Hospital of Basel, Basel, Switzerland.,Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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2
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Kousignian I, Sautereau A, Vigouroux C, Cros A, Kretz S, Viard JP, Slama L. Diagnosis, risk factors and management of diabetes mellitus in HIV-infected persons in France: A real-life setting study. PLoS One 2021; 16:e0250676. [PMID: 33990121 PMCID: PMC8121550 DOI: 10.1371/journal.pone.0250676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 03/24/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a major and increasing public health problem that may be underdiagnosed and undertreated among persons living with HIV (PLWH). OBJECTIVE To describe the diagnosis, treatment and follow-up of DM among PLWH. METHODS This study was performed inside a monocentric cohort of 1494 PLWH. DM was defined as having a FG ≥126 mg/dL twice or a HbA1c ≥6.5%, or a history of diabetes, or receiving antidiabetic treatment. The first visit mentioning a diagnosis of DM was considered as the baseline visit. Chi-Square or Fisher exact test were used to examine the association between categorical variables and DM, Wilcoxon or Student t-test were used for continuous variables. RESULTS 156 PLWH with DM were included. Compared to non-diabetic participants, they were more likely to be native of Sub Saharan Africa (31.6% vs. 22.4%, p = 0.027) and older (54.6 vs. 49.9 years, p<0.001), to have a higher BMI (> 25 for 46.1% vs. 35.3%, p = 0.020) and a poorer control of HIV (HIV RNA<50 copies/mL: 80.1% vs. 89.5%, p<0.001). The diagnosis of DM was missed in 37.8% of PLWH, and 47.2% of PLWH treated for DM did not reach a HbA1c<7%. PLWH with DM were more frequently on antihypertensive and/or lipid-lowering medications: 94.2% had a LDL-cholesterol <70 mg/dL and 60.9% had a blood pressure <140/90 mmHg. CONCLUSION In a setting of HIV-control, HIV care providers should focus on metabolic issues. The management of DM and associated risk factors is mandatory to prevent cardiovascular disease in PLWH.
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Affiliation(s)
- Isabelle Kousignian
- Unité de Recherche « Biostatistique, Traitement et Modélisation des données biologiques » BioSTM—UR 7537, Université de Paris, Paris, France
| | - Aurélie Sautereau
- Department of infectious diseases, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu Hospital, Paris, France
- Department of infectious diseases, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Corinne Vigouroux
- Sorbonne Université, Inserm UMR S 938, Saint-Antoine Research Center, University Hospital Institute of Cardio-metabolism and Nutrition (ICAN), Paris, France
- Departments of Endocrinology and of Molecular Genetics, Assistance Publique-Hôpitaux de Paris, Saint-Antoine Hospital, National Reference Centre of Rare Diseases of Insulin Secretion and of Insulin Sensitivity (PRISIS), Paris, France
| | - Agnès Cros
- Department of infectious diseases, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu Hospital, Paris, France
- COREVIH Ile de France Sud, Hôpital Henri Mondor, Creteil, France
| | - Sandrine Kretz
- Centre de Diagnostic et de Thérapeutique, Hôpital Hôtel Dieu, Paris, France
| | - Jean Paul Viard
- Department of infectious diseases, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu Hospital, Paris, France
- CNRS 8104/INSERM U1016, Institut Cochin, Université de Paris, Paris, France
| | - Laurence Slama
- Department of infectious diseases, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu Hospital, Paris, France
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3
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Cuomo G, Raimondi A, Rivasi M, Guaraldi G, Borghi V, Mussini C. Adherence to Lipid-Lowering Medication in People Living with HIV: An Outpatient Clinic Drug Direct Distribution Experience. J Res Pharm Pract 2021; 10:10-16. [PMID: 34295847 PMCID: PMC8259599 DOI: 10.4103/jrpp.jrpp_20_96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/12/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Adherence to lipid-lowering drugs could be challenging in our patients as it is in the general population, which is described as low as 25%. Our aim was to evaluate adherence to statins and to investigate clinical event impact on it. METHODS This retrospective study on HIV+ patients attending to Clinic of Modena (Italy) was conducted in order to evaluate characteristics, clinical events, and adherence on lipid-lowering drugs. All drugs for comorbidities are distributed by the hospital pharmacy and recorded in an electronical database. Adherence was also evaluated in patients who were supplied with antilipemics in external pharmacies through phone calls. Patients were considered adherent if the percentage of correct time of drug refill was >80%. FINDINGS Totally 1123 patients were evaluated. Lipid-lowering drugs (statins, fenofibrate, and omega-3 oil) were prescribed in 242 patients (21.5%). Prescription occurred mainly in those who were older, males, and Italians. Two hundred of them (82.6%) used statins alone, 23 (9.5%) only fenofibrate or omega-3 oil, and 19 (7.8%) a combination of both drugs. The median adherence was 90% while patients with adherence >80% resulted 153 (63.2%). Forty-six (19%) had a clinical history of cardiovascular events; 59% of them, placed in secondary prophylaxis, and 76%, already in treatment, continued to adhere. No differences in terms of adherence according to the type of drug distribution (hospital pharmacy or outside pharmacies) were found. CONCLUSION Linking the supply of these drugs to that of antiretrovirals led to a good level of adherence higher than that described in the general population. The majority of the patients who experienced a cardiovascular event remain adherent to the prescribed therapy.
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Affiliation(s)
- Gianluca Cuomo
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Alessandro Raimondi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | | | - Giovanni Guaraldi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Vanni Borghi
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Di Modena, Modena, Italy
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Kettelhut A, Bowman E, Funderburg NT. Immunomodulatory and Anti-Inflammatory Strategies to Reduce Comorbidity Risk in People with HIV. Curr HIV/AIDS Rep 2020; 17:394-404. [PMID: 32535769 DOI: 10.1007/s11904-020-00509-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW In this review, we will discuss treatment interventions targeting drivers of immune activation and chronic inflammation in PWH. RECENT FINDINGS Potential treatment strategies to prevent the progression of comorbidities in PWH have been identified. These studies include, among others, the use of statins to modulate lipid alterations and subsequent innate immune receptor activation, probiotics to restore healthy gut microbiota and reduce microbial translocation, hydroxychloroquine to reduce immune activation by altering Toll-like receptors function and expression, and canakinumab to block the action of a major pro-inflammatory cytokine IL-1β. Although many of the treatment strategies discussed here show promise, due to the complex nature of chronic inflammation and comorbidities in PWH, larger clinical studies are needed to understand and target the prominent drivers and inflammatory cascades underlying these end-organ diseases.
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Affiliation(s)
- Aaren Kettelhut
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA
| | - Emily Bowman
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA
| | - Nicholas T Funderburg
- Division of Medical Laboratory Science, School of Health and Rehabilitation Sciences, Ohio State University College of Medicine, Columbus, OH, USA.
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Wallace DE, Horberg MA, Benator DA, Greenberg AE, Castel AD, Monroe AK, Happ LP. Diabetes mellitus control in a large cohort of people with HIV in care-Washington, D.C. AIDS Care 2020; 33:1464-1474. [PMID: 32811173 DOI: 10.1080/09540121.2020.1808160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
With more effective antiretroviral therapy (ART), people with HIV (PWH) are living longer and have more chronic diseases, including diabetes mellitus (DM). The prevalence of DM has been estimated in PWH previously, however there is less research regarding DM control. Our objectives were to determine the prevalence of DM and DM control and determine factors associated with DM control in a large urban cohort of PWH in care. We examined DC Cohort participants aged ≥18 years old to determine DM prevalence and to assess DM control (HbA1c measurement <7.0%). Demographic, clinical, and HIV-related factors associated with DM control were identified using multivariate logistic regression. The cohort of 5876 participants was predominantly male (71.3%), Non-Hispanic Black (78.1%) and had a median age of 52.0 years. DM prevalence was 17.4% (1023/5876). Among participants with recent HbA1c data available (39.9%) the proportion with DM control was 60.0% (245/408). In multivariate analysis, higher BMI (aOR: 0.47; 95% CI 0.28, 0.79) and use of non-insulin DM medication (aOR 0.43, 95% CI 0.25, 0.73) or insulin (aOR 0.010, 95% CI 0.04,0.24) compared to no medication use. Our findings suggest that individuals on medication for their DM likely need enhanced support to reach their treatment goals.
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Affiliation(s)
- David E Wallace
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Michael A Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD, USA
| | - Debra A Benator
- Division of Infectious Disease, Veterans Affairs Medical Center, Washington, DC, USA.,Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Alan E Greenberg
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Amanda D Castel
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Anne K Monroe
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - Lindsey Powers Happ
- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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- Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Wollner G, Zimpfer D, Manduric M, Laufer G, Rieger A, Sandner SE. Outcomes of coronary artery bypass grafting in patients with human immunodeficiency virus infection. J Card Surg 2020; 35:2543-2549. [PMID: 32652674 PMCID: PMC7586791 DOI: 10.1111/jocs.14828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background With early and effective antiretroviral therapy and improved survival for persons living with human immunodeficiency virus infection (PLHIV), this patient population now faces an increasingly elevated risk of cardiovascular disease. However, the data on outcomes after coronary artery bypass grafting (CABG) for revascularization of coronary artery disease (CAD) in HIV+ patients is limited. Methods We conducted a retrospective analysis of 16 patients undergoing isolated CABG at the Medical University of Vienna from 2005 to 2018, who were HIV+ on admission. The primary endpoint of the study was survival. Secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization. Results Patients were followed for a median of 49 months (range, 7‐142 months). Survival was 100% and 90% at 1 and 3 years after CABG, respectively. There were no strokes. MI and subsequent repeat revascularization were observed in two patients. Conclusion CABG provides excellent short‐ and midterm survival and freedom from MACCE in HIV+ patients with CAD requiring revascularization.
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Affiliation(s)
- Gregor Wollner
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Daniel Zimpfer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Marina Manduric
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Armin Rieger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Sigrid E Sandner
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
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Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, Grinspoon SK, Levin J, Longenecker CT, Post WS. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e98-e124. [PMID: 31154814 DOI: 10.1161/cir.0000000000000695] [Citation(s) in RCA: 373] [Impact Index Per Article: 74.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
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8
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Riestenberg RA, Furman A, Cowen A, Pawlowksi A, Schneider D, Lewis AA, Kelly S, Taiwo B, Achenbach C, Palella F, Stone NJ, Lloyd-Jones DM, Feinstein MJ. Differences in statin utilization and lipid lowering by race, ethnicity, and HIV status in a real-world cohort of persons with human immunodeficiency virus and uninfected persons. Am Heart J 2019; 209:79-87. [PMID: 30685678 DOI: 10.1016/j.ahj.2018.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Risks for cardiovascular diseases, including myocardial infarction and stroke, are elevated in people with HIV infection (PWH). However, no trials of statin utilization with clinical cardiovascular disease (CVD) end points have been completed in PWH, and there are sparse real-world data regarding statin use and lipid-lowering effectiveness. We therefore used a unique cohort of PWH and uninfected controls to evaluate (1) differences in statin types used for PWH versus uninfected persons; (2) lipid lowering achieved by statin use for PWH versus uninfected persons; and (3) racial and ethnic disparities in appropriate statin use among PWH and uninfected persons. METHODS We analyzed a cohort of 5,039 PWH and 10,011 uninfected demographically matched controls who received care at a large urban medical center between January 1, 2000, and May 17, 2017. Medication administration records, prescription data, and validated natural language processing algorithms were used to determine statin utilization. Statins were categorized by generic active ingredient name and intensity (high, moderate, or low). Lipid values collected in routine clinical care were available for analysis. The first set of analyses was restricted to PWH and uninfected matched controls taking statins and compared (1) differences in statin type and (2) difference in cholesterol levels after versus before statin initiation by HIV status. For the second set of analyses, we first used prevalent CVD risk factors to determine participants with statin indications and then determined how many of these participants were taking statins. We then compared statin utilization among persons with indications for statins by race/ethnic group for PWH and uninfected matched controls using multivariable-adjusted logistic regression. RESULTS Among people prescribed statins, PWH were more likely than controls to have ever taken pravastatin (34.8% vs 12.3%, P < .001) or atorvastatin (72.2% vs 65.6%, P = .002) and less likely to have ever taken simvastatin (14.2% vs 39.5%, P < .001). Among PWH with indications for statin utilization, 55.7% of whites, 39.4% of blacks, and 45.8% of Hispanics were prescribed statins (P < .001). These differences in statin prescription by race/ethnicity remained significant after adjustment for demographics (including insurance status), cardiovascular risk factors, antiretroviral therapy use, HIV viremia, and CD4 count. These racial/ethnic disparities in statin utilization were less pronounced among uninfected persons. CONCLUSIONS Among PWH with statin indication(s), blacks and Hispanics were less likely than whites to have been prescribed a statin. These racial/ethnic disparities were less pronounced among uninfected persons. There were significant differences in type of statin used for PWH compared to uninfected matched controls. Future efforts addressing disparities in CVD prevention among PWH are warranted.
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Affiliation(s)
| | - Andrew Furman
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Avery Cowen
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anna Pawlowksi
- Northwestern Medicine Enterprise Data Warehouse, Chicago, IL
| | | | - Alana A Lewis
- University of Texas - Southwestern Medical Center, Dallas, TX
| | - Sean Kelly
- Vanderbilt University Medical Center, Nashville, TN
| | - Babafemi Taiwo
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Chad Achenbach
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank Palella
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neil J Stone
- Northwestern University Feinberg School of Medicine, Chicago, IL
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Mosepele M, Molefe-Baikai OJ, Grinspoon SK, Triant VA. Benefits and Risks of Statin Therapy in the HIV-Infected Population. Curr Infect Dis Rep 2018; 20:20. [PMID: 29804227 DOI: 10.1007/s11908-018-0628-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW HIV-infected patients face an increased risk for cardiovascular disease (CVD), estimated at 1.5- to 2-fold as compared to HIV-uninfected persons. This review provides a recent (within preceding 5 years) summary of the role of statin therapy and associated role in CVD risk reduction among HIV-infected patients on anti-retroviral therapy. RECENT FINDINGS Statins remain the preferred agents for reducing risk for CVD among HIV-infected populations based on guidance extrapolated from general population (HIV-uninfected) cholesterol treatment guidelines across different settings globally. However, HIV-infected patients are consistently under prescribed statin therapy when compared to their HIV-uninfected counterparts. The most commonly studied statins in clinical care and small randomized and cohort studies have been rosuvastatin and atorvastatin. Both agents are preferred for their potent lipid-lowering effects and their favorable or neutral pleotropic effects on chronic inflammation, renal function, and hepatic steatosis among others. However, growing experience with the newer glucuronidated pitavastatin suggests that this agent has virtually no adverse drug interactions with ART or effects on glucose metabolism-all marked additional benefits when compared with rosuvastatin and atorvastatin while maintaining comparable anti-lipid effects. Pitavastatin is therefore the statin of choice for the ongoing largest trial (6500 participants) to test the benefits of statin therapy among HIV-infected adults. Statins are underutilized in the prevention of CVD in HIV-infected populations based on criteria in established cholesterol guidelines. There is a potential role for statin therapy for HIV-infected patients who do not meet guideline criteria which will be further delineated through ongoing clinical trials.
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Affiliation(s)
- Mosepele Mosepele
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana. .,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana. .,Sir Ketumile Masire Teaching Hospital, Faculty of Medicine, University of Botswana, 3rd Floor, Block F, Room F4069, Gaborone, Botswana.
| | | | - Steven K Grinspoon
- Program in Nutritional Metabolism, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Virginia A Triant
- Divisions of Infectious Diseases and General Internal Medicine, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
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Burkholder GA, Muntner P, Zhao H, Mugavero MJ, Overton ET, Kilgore M, Drozd DR, Crane HM, Moore RD, Mathews WC, Geng E, Boswell S, Floris-Moore M, Rosenson RS. Low-density lipoprotein cholesterol response after statin initiation among persons living with human immunodeficiency virus. J Clin Lipidol 2018; 12:988-998.e5. [PMID: 29853312 DOI: 10.1016/j.jacl.2018.03.082] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/25/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Meta-analyses of general population studies report mean low-density lipoprotein cholesterol (LDL-C) reductions of 30% to <50% with moderate-intensity and ≥50% with high-intensity statins. Persons living with human immunodeficiency virus (PLWH) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet many have elevated LDL-C. OBJECTIVE To evaluate LDL-C response after statin initiation among PLWH. METHODS We conducted a retrospective cohort study of PLWH initiating statins between 2009 and 2013 (N = 706). Patients were categorized into mutually exclusive groups in the following hierarchy: history of coronary heart disease (CHD), diabetes, prestatin LDL-C ≥190 mg/dL, 10-year predicted ASCVD risk ≥7.5%, and none of the above (ie, unknown statin indication). The primary outcome was a ≥30% reduction in LDL-C after statin initiation. RESULTS Among patients initiating statins, 5.8% had a history of CHD, 13.6% had diabetes, 6.2% had LDL-C ≥190 mg/dL, 35.4% had 10-year ASCVD risk ≥7.5%, and 39.0% had an unknown statin indication. Among patients with a history of CHD, 31.7% achieved a ≥30% LDL-C reduction compared with 25.0%, 59.1%, and 33.9% among those with diabetes, LDL-C ≥190 mg/dL, and 10-year ASCVD risk ≥7.5%, respectively. In multivariable adjusted analyses and compared to patients with an unknown statin indication, LDL-C ≥ 190 mg/dL was associated with a prevalence ratio for an LDL-C reduction ≥30% of 1.81 (95% confidence interval, 1.34-2.45), whereas no statistically significant association was present for history of CHD, diabetes, and 10-year ASCVD risk ≥7.5%. CONCLUSION A low percentage of PLWH achieved the expected reductions in LDL-C after statin initiation, highlighting an unmet need for ASCVD risk reduction.
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Affiliation(s)
- Greer A Burkholder
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hong Zhao
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - E Turner Overton
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Meredith Kilgore
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel R Drozd
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Elvin Geng
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Boswell
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Michelle Floris-Moore
- Department of Medicine, Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert S Rosenson
- Department of Medicine, Mount Sinai Icahn School of Medicine, New York, NY, USA
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Levy ME, Greenberg AE, Magnus M, Younes N, Castel A, Subramanian T, Binkley J, Taylor R, Rayeed N, Akridge C, Purinton S, Moog R, Naughton J, D'Angelo L, Rakhmanina N, Kharfen M, Wood A, Kumar P, Parenti D, Castel A, Greenberg A, Happ LP, Jaurretche M, Lewis B, Peterson J, Younes N, Wilcox R, Rana S, Horberg M, Fernandez R, Hebou A, Dieffenbach C, Masur H, Bordon J, Teferi G, Benator D, Ruiz ME, Goldstein D, Hardy D. Evaluation of Statin Eligibility, Prescribing Practices, and Therapeutic Responses Using ATP III, ACC/AHA, and NLA Dyslipidemia Treatment Guidelines in a Large Urban Cohort of HIV-Infected Outpatients. AIDS Patient Care STDS 2018; 32:58-69. [PMID: 29561173 PMCID: PMC5808384 DOI: 10.1089/apc.2017.0304] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Statin coverage has been examined among HIV-infected patients using Adult Treatment Panel III (ATP III) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines, although not with newer National Lipid Association (NLA) guidelines. We investigated statin eligibility, prescribing practices, and therapeutic responses using these three guidelines. Sociodemographic, clinical, and laboratory data were collected between 2011 and 2016 for HIV-infected outpatients enrolled in the DC Cohort, a multi-center, prospective, observational study in Washington, DC. This analysis included patients aged ≥21 years receiving primary care at their HIV clinic site with ≥1 cholesterol result available. Of 3312 patients (median age 52; 79% black), 52% were eligible for statins based on ≥1 guideline, including 45% (NLA), 40% (ACC/AHA), and 30% (ATP III). Using each guideline, 49% (NLA), 56% (ACC/AHA), and 73% (ATP III) of eligible patients were prescribed statins. Predictors of new prescriptions included older age (aHR = 1.16 [1.08-1.26]/5 years), body mass index ≥30 (aHR = 1.50 [1.07-2.11]), and diabetes (aHR = 1.35 [1.03-1.79]). Hepatitis C coinfection was inversely associated with statin prescriptions (aHR = 0.67 [0.45-1.00]). Among 216 patients with available cholesterol results pre-/post-prescription, 53% achieved their NLA cholesterol goal after 6 months. Hepatitis C coinfection was positively associated (aHR = 1.87 [1.06-3.32]), and depression (aHR = 0.56 [0.35-0.92]) and protease inhibitor use (aHR = 0.61 [0.40-0.93]) were inversely associated, with NLA goal achievement. Half of patients were eligible for statins based on current US guidelines, with the highest proportion eligible based on NLA guidelines, yet, fewer received prescriptions and achieved treatment goals. Greater compliance with recommended statin prescribing practices may reduce cardiovascular disease risk among HIV-infected individuals.
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Affiliation(s)
- Matthew E. Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Alan E. Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Naji Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Amanda Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Thilakavathy Subramanian
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jeffery Binkley
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Rob Taylor
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Nabil Rayeed
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Cheryl Akridge
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Stacey Purinton
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Ryan Moog
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jeff Naughton
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Lawrence D'Angelo
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Natella Rakhmanina
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Michael Kharfen
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Angela Wood
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Princy Kumar
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - David Parenti
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Amanda Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Alan Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Lindsey Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Maria Jaurretche
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Brittany Lewis
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - James Peterson
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Naji Younes
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Ronald Wilcox
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Sohail Rana
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Michael Horberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Ricardo Fernandez
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Annick Hebou
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Carl Dieffenbach
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Henry Masur
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Jose Bordon
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Gebeyehu Teferi
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Debra Benator
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Maria Elena Ruiz
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - Deborah Goldstein
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
| | - David Hardy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia
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van Zoest RA, van der Valk M, Wit FW, Vaartjes I, Kooij KW, Hovius JW, Prins M, Reiss P. Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy. Eur J Prev Cardiol 2017; 24:1297-1307. [PMID: 28578613 PMCID: PMC5548068 DOI: 10.1177/2047487317714350] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/18/2017] [Indexed: 01/12/2023]
Abstract
Background We aimed to identify the prevalence of cardiovascular risk factors, and investigate preventive cardiovascular medication use and achievement of targets as per Dutch cardiovascular risk management guidelines among human immunodeficiency virus (HIV)-positive and HIV-negative individuals. Design The design was a cross-sectional analysis within an ongoing cohort study. Methods Data on medication use and cardiovascular disease prevalence were available for 528 HIV-positive and 521 HIV-negative participants. We identified cardiovascular risk factors and applied cardiovascular risk management guidelines, mainly focusing on individuals eligible for (a) primary prevention because of high a priori cardiovascular risk, or for (b) secondary prevention. Results One hundred and three (20%) HIV-positive and 77 (15%) HIV-negative participants were classified as having high cardiovascular risk; 53 (10%) HIV-positive and 27 (5%) HIV-negative participants were eligible for secondary prevention. Of HIV-positive individuals 57% at high cardiovascular risk and 42% of HIV-positive individuals eligible for secondary prevention had systolic blood pressures above guideline-recommended thresholds. Cholesterol levels were above guideline-recommended thresholds in 81% of HIV-positive individuals at high cardiovascular risk and 57% of HIV-positive individuals eligible for secondary prevention. No statistically significant differences were observed between HIV-positive and HIV-negative participants regarding achievement of targets, except for glycaemic control (glycated haemoglobin ≤ 53 mmol/mol) among individuals using diabetes medication (90% vs 50%, p = 0.017) and antiplatelet/anticoagulant use for secondary prevention (85% vs 63%, p = 0.045), which were both superior among HIV-positive participants. Conclusions Cardiovascular risk management is suboptimal in both HIV-positive and HIV-negative individuals and should be improved.
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Affiliation(s)
- Rosan A van Zoest
- Department of Global Health, Academic Medical Center, The Netherlands
- Amsterdam Institute for Global Health and Development, The Netherlands
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
| | - Ferdinand W Wit
- Department of Global Health, Academic Medical Center, The Netherlands
- Amsterdam Institute for Global Health and Development, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- HIV Monitoring Foundation, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Katherine W Kooij
- Department of Global Health, Academic Medical Center, The Netherlands
- Amsterdam Institute for Global Health and Development, The Netherlands
| | - Joppe W Hovius
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
| | - Maria Prins
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Peter Reiss
- Department of Global Health, Academic Medical Center, The Netherlands
- Amsterdam Institute for Global Health and Development, The Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, Amsterdam, the Netherlands
- HIV Monitoring Foundation, The Netherlands
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13
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Levy ME, Greenberg AE, Hart R, Powers Happ L, Hadigan C, Castel A. High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC. HIV Med 2017; 18:724-735. [PMID: 28503912 DOI: 10.1111/hiv.12516] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
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, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates. METHODS Utilizing an electronic medical record (EMR) database from the DC Cohort study - a multicentre prospective cohort study of HIV-infected outpatients - we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results. RESULTS Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49-51] had hypertension, 13% (95% CI: 12-14) had diabetes, 48% (95% CI: 47-49) had dyslipidaemia, and 35% (95% CI: 34-36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, 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 immunovirological 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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Affiliation(s)
- M E Levy
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - A E Greenberg
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - R Hart
- Research Department, Cerner Corporation, Kansas City, MO, USA
| | - L Powers Happ
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
| | - C Hadigan
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - A Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University, Washington, DC, USA
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Shen Y, Wang J, Wang Z, Qi T, Song W, Tang Y, Liu L, Zhang R, Lu H. Prevalence of Dyslipidemia Among Antiretroviral-Naive HIV-Infected Individuals in China. Medicine (Baltimore) 2015; 94:e2201. [PMID: 26632908 PMCID: PMC4674211 DOI: 10.1097/md.0000000000002201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Little is known about the epidemiological features of dyslipidemia among antiretroviral-naive HIV-infected individuals in China. We used a cross-sectional study design to estimate the prevalence of dyslipidemia in this population, and to identify risk factors associated with the presence of dyslipidemia. One thousand five hundred and eighteen antiretroviral-naive HIV-infected individuals and 347 HIV-negative subjects in China were enrolled during 2009 to 2010. Demographics and medical histories were recorded. After an overnight fast, serum samples were collected to measure lipid levels. Factors associated with the presence of dyslipidemia were analyzed by logistic regression. Mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL) levels were lower in HIV-positive than HIV-negative subjects, but mean triglyceride (TG) was higher in HIV-positive subjects. The overall prevalence of dyslipidemia in HIV-positive and HIV-negative groups did not differ (75.6% vs. 73.7%, P = 0.580). However, the prevalence of high TC (8.4% vs. 28.2%, P < 0.001) and high LDL (8.5% vs. 62.6%, P < 0.001) was lower in HIV-positive than HIV-negative subjects, and the prevalence of high TG (33.9% vs. 17.0%, P < 0.001) and low HDL (59.6% vs. 11.2%, P < 0.001) was higher in HIV-positive than HIV-negative subjects. Logistic analysis showed that HIV positivity was significantly associated with both an increased risk of high TG and low HDL and a decreased risk of high TC and high LDL. The mean levels of TC, of LDL and of HDL showed an increasing trend with increasing CD4 count in HIV-positive subjects. Multivariable logistic regression found that lower CD4 count was significantly associated with both an increased risk of high TG and low HDL and a decreased risk of high TC in HIV-positive subjects. Among antiretroviral-naive HIV-infected Chinese adults, there was a high prevalence of dyslipidemia characterized by high TG and low HDL, which was associated with lower CD4 counts. These data support the assessment of lipid profiles before and after initiation of antiretroviral therapy regardless of age.
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Affiliation(s)
- Yinzhong Shen
- From the Department of Infectious Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China (YS, JW, ZW, TQ, WS, YT, LL, RZ, HL)
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