Assessment of atherosclerotic cardiovascular disease risks between people living with HIV receiving first-line and second-line antiretroviral therapy in a resource-limited setting

2021 ◽  
Vol 32 (5) ◽  
pp. 421-426
Author(s):  
Jaruwan Tiarukkitsagul ◽  
Somnuek Sungkanuparph
Keyword(s):  
Cardiovascular Disease ◽  
People Living With Hiv ◽  
Atherosclerotic Cardiovascular Disease ◽  
Second Line ◽  
First Line ◽  
Resource Limited ◽  
Ascvd Risk ◽  
The Mean ◽  
Living With Hiv ◽  
Limited Setting

Cardiovascular disease has become an important health problem in people living with HIV (PLHIV) who receive antiretroviral therapy (ART). Atherosclerotic cardiovascular disease (ASCVD) risk score is a non-invasive tool to estimate the 10-year risk for ASCVD. A cross-sectional study was conducted among PLHIV receiving ART in a resource-limited setting, in order to assess the 10-year ASCVD risk between PLHIV receiving first-line and second-line ART. Of 460 participants with a mean age of 51.2 years, 262 (57.0%) were men. The mean duration of HIV infection was 14.7 years and the mean CD4 cell count was 509 cells/μL. Of all, 345 participants were receiving first-line ART and 115 were receiving second-line ART. The median 10-year ASCVD risk was 3.0% and 5.1% in the first-line and second-line ART groups, respectively ( p = 0.029). The prevalence of a high 10-year ASCVD risk (≥20%) was significantly higher in the second-line ART group (3.5% vs 0.9%, p = 0.048). In multivariate analysis, receiving second-line ART was significantly associated with intermediate to high 10-year ASCVD risk (OR = 2.952; 95% CI, 1.656–6.997; p = 0.015). Atherosclerotic cardiovascular disease risk should be assessed in PLHIV, particularly those who receive second-line ART.

Patients Living With HIV Are Less Likely to Receive Appropriate Statin Therapy for Cardiovascular Disease Risk Reduction

2021 ◽  
pp. 089719002199979
Author(s):  
Roshni P. Emmons ◽  
Nicholas V. Hastain ◽  
Todd A. Miano ◽  
Jason J. Schafer
Keyword(s):  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Blood Cholesterol ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Ascvd Risk ◽  
Living With Hiv ◽  
To Receive

Background: Recent studies suggest that statins are underprescribed in patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD), but none have assessed if eligible patients receive the correct statin and intensity compared to uninfected controls. Objectives: The primary objective was to determine whether statin-eligible PLWH are less likely to receive appropriate statin therapy compared to patients without HIV. Methods: This retrospective study evaluated statin eligibility and prescribing among patients in both an HIV and internal medicine clinic at an urban, academic medical center from June-September 2018 using the American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk. Patients were assessed for eligibility and actual treatment with appropriate statin therapy. Characteristics of patients appropriately and not appropriately treated were compared with chi-square testing and predictors for receiving appropriate statin therapy were determined with logistic regression. Results: A total of 221/300 study subjects were statin-eligible. Fewer statin-eligible PLWH were receiving the correct statin intensity for their risk benefit group versus the uninfected control group (30.2% vs 67.0%, p < 0.001). In the multivariable logistic regression analysis, PLWH were significantly less likely to receive appropriate statin therapy, while those with polypharmacy were more likely to receive appropriate statin therapy. Conclusion: Our study reveals that PLWH may be at a disadvantage in receiving appropriate statin therapy for ASCVD risk reduction. This is important given the heightened risk for ASCVD in this population, and strategies that address this gap in care should be explored.

scholarly journals Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV

Circulation ◽  
2018 ◽  
Vol 138 (11) ◽  
pp. 1100-1112 ◽  
Author(s):  
Anoop S.V. Shah ◽  
Dominik Stelzle ◽  
Kuan Ken Lee ◽  
Eduard J. Beck ◽  
Shirjel Alam ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Global Burden ◽  
People Living With Hiv ◽  
Atherosclerotic Cardiovascular Disease ◽  
Living With Hiv

scholarly journals 338. Patients Living with HIV Infection Are Less Likely to Receive the Correct Intensity of Statin Therapy for Cardiovascular Disease Risk Reduction

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S179-S180
Author(s):  
Jason J Schafer ◽  
Roshni Patel ◽  
Nicholas V Hastain ◽  
Todd Miano
Keyword(s):  
Cardiovascular Disease ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Univariate Analysis ◽  
Blood Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Panel ◽  
Ascvd Risk ◽  
Living With Hiv ◽  
To Receive

Abstract Background Patients living with HIV (PLWH) at risk for atherosclerotic cardiovascular disease (ASCVD) should receive risk reduction interventions recommended in current guidelines. This includes routine ASCVD risk assessments and when eligible, statins selected and dosed to achieve appropriate low-density lipoprotein cholesterol (LDL-C) reduction. Recent studies suggest that statins are underprescribed in PLWH, but none have assessed if eligible patients receive the correct statin intensity compared with uninfected controls. Methods This retrospective study evaluated statin eligibility and prescribing among consecutive patients in an HIV clinic and an internal medicine clinic at an urban, academic medical center from June-September 2018. To determine statin eligibility, the 2013 American College of Cardiology/American Heart Association guideline on treating blood cholesterol to reduce ASCVD risk was used. Patients aged 40–75 that had a lipid panel obtained within the last year were included. All patients were assessed to determine eligibility for and actual treatment with appropriate statin therapy. Characteristics of patients correctly and incorrectly treated with statins were compared with chi-square testing and predictors for receiving correct statin therapy were determined with logistic multivariable regression. Results A total of 221/300 study subjects were statin eligible (Table 1). While many eligible PLWH were receiving a statin (54/106), considerably fewer were on the correct statin intensity for their benefit group (33/106). In the univariate analysis (Table 2), correctly treated patients were less likely to be PLWH or female, and were more likely to have polypharmacy and hypertension. In the multivariable logistic regression analysis (Table 3), PLWH (OR 0.26, CI95 0.12–0.57)) were significantly less likely to receive correct statin therapy, while those with concomitant polypharmacy were significantly more likely to receive correct statin therapy (OR 5.52, CI95 1.94, 15.69). Conclusion This study reveals that PLWH may be at a substantial disadvantage in terms of receiving correct statin therapy for ASCVD risk reduction. This finding may be particularly important given the heightened risk for ASCVD in this patient population. Disclosures All authors: No reported disclosures.

scholarly journals Response to First-Line Antiretroviral Therapy Among PLHIV from a High-Risk, Low-Prevalence Setting

2019 ◽  
Vol 18 ◽  
pp. 232595821986732
Author(s):  
Shahria Mohammad Rashed Ul Islam ◽  
Munira Jahan ◽  
Afzalun Nessa ◽  
Shahina Tabassum
Keyword(s):  
Antiretroviral Therapy ◽  
T Lymphocyte ◽  
Lymphocyte Count ◽  
Study Groups ◽  
People Living With Hiv ◽  
First Line ◽  
Cd8 T Lymphocyte ◽  
The Mean ◽  
Low Prevalence ◽  
Living With Hiv

The study reports the response of first-line antiretroviral therapy (ART) by assessing CD4 and CD8 T-lymphocyte and viral load (VL) among Bangladeshi people living with HIV (PLHIV). This observational approach was conducted on 100 PLHIVs, grouped into therapy naive (n = 33), therapy initiators with CD4 T-cell count of <350 cells/µL (n = 33), and therapy receivers for >1 year prior to the study period (n = 34). Therapy initiators who continued the study (n = 20) were followed up after 12 and 24 weeks of therapy initiation. The CD4 and CD8 T-lymphocyte count estimation and (VL) were quantified. The mean CD4 T-lymphocyte count was significantly reduced among the therapy initiators in comparison to therapy naive and therapy receivers. Similar findings were observed for CD8 T-lymphocyte count among the study groups. The mean HIV-1 RNA VL among therapy initiators showed a significant decrease after 12 and 24 weeks, and 85% patients in this group obtained undetectable VL status indicating the good therapeutic outcome.

scholarly journals Assessment of renal function in routine care of people living with HIV on ART in a resource-limited setting in urban Zambia

PLoS ONE ◽  
2017 ◽  
Vol 12 (9) ◽  
pp. e0184766 ◽  
Author(s):  
Andreas Deckert ◽  
Florian Neuhann ◽  
Christina Klose ◽  
Thomas Bruckner ◽  
Claudia Beiersmann ◽  
...  
Keyword(s):  
Renal Function ◽  
Routine Care ◽  
Resource Limited Setting ◽  
People Living With Hiv ◽  
Resource Limited ◽  
Living With Hiv ◽  
Limited Setting

scholarly journals Comparison of Treatment Outcomes among Second-Line Antiretroviral Regimens in HIV/AIDS Patient

2018 ◽  
Vol 8 (3) ◽  
pp. 119
Author(s):  
Winda Dwi Puspitasari ◽  
Nanang Munif Yasin ◽  
Fita Rahmawati
Keyword(s):  
Opportunistic Infections ◽  
People Living With Hiv ◽  
Severe Toxicity ◽  
Second Line ◽  
Inclusion Criteria ◽  
First Line ◽  
Cohort Design ◽  
Record Data ◽  
Living With Hiv ◽  
Hiv Aids

Antiretroviral (ARV) therapy can increase life expectancy of people living with HIV/AIDS (PLWHA). If the therapy fails and causes severe toxicity to first-line ARV, the first-line ARV regimen is switched to the second line. Studies on the outcome of the second-line ARV therapy have not been widely conducted in Indonesia. This study aims to identify the comparison of outcomes of the second-line ARV therapy regimens in HIV/AIDS patients. The study employed retrospective cohort design. Medical record data were collected from patients treated from January 2008 until December 2017 at Dr. Kariadi Hospital of Semarang. The number of samples that met the inclusion criteria was 42 patients. The comparison between incidence of opportunistic infections and survival among the regimens was presented descriptively. The comparison of regimens based on changes in CD4 level was performed by using Kruskal-Wallis test. The switch occurred in 24 patients (57.14%) due to toxicity of the first-line ARV and in 18 patients (42.86%) due to treatment failure. Mean CD4 and viral load during the switches were 164.68 ± 204.98 cells/mm3, 154,726.14 ± 296,797.12 copies/ml respectively. After 6 months of the second-line ARV therapy, there was an increase in CD4 level (p 0.05) among the three regimens after 6 months of the second-line ARV therapy.

scholarly journals 941. Incarcerated patients living with HIV: Atherosclerotic cardiovascular disease risk and management

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S503-S504
Author(s):  
Sarah M Michienzi ◽  
Thomas D Chiampas ◽  
Amy Valkovec ◽  
Siria Arzuaga ◽  
Mahesh C Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Statin Therapy ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Panel ◽  
Ascvd Risk ◽  
Living With Hiv

Abstract Background The 2018 American Heart Association and American College of Cardiology (AHA/ACC) 2018 Guideline on the Management of Blood Cholesterol included human immunodeficiency virus (HIV) as an atherosclerotic cardiovascular disease (ASCVD) risk enhancer for the first time. Our study investigates if patients living with HIV in the Illinois Department of Corrections (IDOC) were prescribed appropriate HMG-CoA reductase inhibitor (statin) therapy following release of these guidelines based on risk. Methods This was a retrospective study of patients with &gt; 1 visit in our multidisciplinary HIV IDOC Telemedicine Clinic from 1/1/19-6/1/19. Our prescriptive authority is limited to HIV and directly related conditions, and we provide recommendations to on-site providers for other comorbidities. Included patients were &gt; 18 years of age, HIV positive, and incarcerated within IDOC. Excluded patients had existing ASCVD. Data from the first visit in the study period were extracted from the electronic medical record and analyzed utilizing descriptive statistics. Primary objectives were to quantify ASCVD risk and appropriate statin use in our population. Results Of the 158 patients included, average age was 42 years. The majority were male (89%), Black (73%), overweight/obese (117/148, 79%), on an integrase single-tablet regimen (78%), with CD4 &gt;200 cells/µL (97%), and HIV RNA &lt; 20 copies/mL (85%). Of the 18 females, 8 were transgender. Within the prior year, 65% had a lipid panel. For the 50 patients meeting criteria for 10-year ASCVD estimation, median (range) risk was 6.6% (0.8% - 31.9%). Only 12 patients were on statins. Of these, all were indicated per AHA/ACC guidelines with 10 prescribed appropriate intensity. An additional 45 patients had indications for statins but were untreated. In total, 47 patients (30%) were not receiving appropriate statin therapy. Conclusion Results of our study suggest ASCVD risk management is an area of improvement for inmates living with HIV, especially as we look towards caring for an aging HIV population. Future directions include comparing these data to data from a later time point to evaluate time for guideline uptake. Disclosures Thomas D. Chiampas, PharmD, BCPS, AAHIVP, Gilead (Employee)

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