HIV Patients Lack Adequate Control of CVD Risk Factors

Most patients with HIV infection receive treatment for high low-density lipoprotein cholesterol (LDL-C) levels or hypertension. Yet a significant percentage of these patients do not have adequate control of these cardiovascular disease (CVD) risk factors, according to a new study.

“As patients with HIV are at higher risk for CVD and living to an age where CVD is more common, it will be important to identify ways to better manage and control CVD risk factors in this patient population.” So say the authors, led by Merle Myerson, MD, EdD, of the Division of Cardiology at Mount Sinai St. Luke's and Mount Sinai Roosevelt Hospital in New York City.

The introduction of antiretroviral therapy has largely turned HIV infection in a chronic disease. With this evolution in place, CVD is now a leading cause of morbidity and mortality in this patient group. Patients with HIV have a 2-fold increased risk for myocardial infarction compared with those without HIV infection, note the authors. The underlying causes for this increased risk include metabolic alterations, such as deposition of body fat, insulin resistance, high blood pressure, and abnormal lipid levels, resulting from the HIV itself; dyslipidemia induced by antiretroviral medications, in particular protease inhibitors; and increasing age and associated CVD risk factors of HIV-infected patients.

“Although much has been written on the prevalence, treatment, and control of CVD risk factors in the general population, there is relatively less information available on HIV-infected patients, especially treatment and control rates among patients with recognized HIV,” they state.

The researchers conducted a cross-sectional study to determine the prevalence of LDL-C dyslipidemia and hypertension among HIV patients in an urban HIV/AIDS clinic that provides comprehensive care. They also set out to describe the treatment and control of these risk factors, and examine factors potentially associated with successful control of dyslipidemia and hypertension in these patients.

Their study reviewed electronic medical records of nearly 4300 HIV-infected adult patients at a designated New York State AIDS Center in New York City. The population was diverse, including about one-quarter of them women, an age range from 20 to 87 years, varied risk sources for HIV, and a mix of race/ethnicity reflective of a large urban population.

The prevalence of LDL-C dyslipidemia was 35%. Virtually all (90%) of the patients with LDL-C dyslipidemia were treated, and three-quarters of these patients were treated at goal. Patients in high-risk groups (56%), including known coronary heart disease (57%) or coronary heart disease equivalents (62%), were less likely to be at LDL-C goal.

The prevalence of hypertension was 43%. Three-quarters of patients with hypertension were treated, but “control was poor, with 57% of the patients at goal blood pressure,” they state.

Since CVD is becoming a leading cause of morbidity and mortality in these patients, the authors suggest that their findings could “provide a basis for further investigation regarding optimal treatment regimens and may support the development of guidelines specific to this population of patients.”

The researchers published their results in August 1, 2014 issue of Journal of Acquired Immune Deficiency Syndromes.