Comorbidity-Related Treatment Outcomes among HIV-Infected Adults in the Bronx, NY

Abstract

Aging, HIV infection, and antiretroviral therapy have been associated with increasing rates of chronic comorbidities in patients with HIV. Urban minority populations in particular are affected by both the HIV/AIDS and chronic disease epidemics. Our objectives were to estimate the prevalence of and risk factors for hypertension, dyslipidemia, and diabetes among HIV-infected adults in the Bronx and describe comorbidity-related treatment outcomes. This was a cross-sectional study of 854 HIV-positive adults receiving care at 11 clinics which provide HIV primary care services; clinics were affiliated with a large urban academic medical center. Data on blood pressure (BP), cholesterol, and glycemic control were collected through standardized chart review of outpatient medical records. We found prevalence rates of 26%, 48%, and 13% for hypertension, dyslipidemia, and diabetes, respectively. Older age, obesity, family history, and current protease inhibitor use were consistently associated with comorbidity. Diabetes treatment goals were achieved less often than BP and lipid goals, and concurrent diabetes was a significant predictor for BP and lipid control. In conclusion, major cardiovascular-related comorbidities are prevalent among HIVpositive adults in the Bronx, especially older and obese individuals. Differences exist in comorbidity-related treatment outcomes, especially for patients with concurrent diabetes. Because cardiovascular risk is modifiable, effective treatment of related comorbidities may improve morbidity and mortality in HIV-infected patients.

Adverse Effect Profile of Tenofovir Disoproxil Fumarate in Hiv Positive Patients - A Prospective Study

“…The prevalence of comorbidities like hypertension, dyslipidaemia and diabetes were lesser when compared to the study by Chu C et al 13 who noticed prevalence rates of 26%, 48% and 13% for hypertension, dyslipidaemia and diabetes respectively, which may be due to differences in the ethnicity and the higher sample size of 854 studied there. Elevation in liver enzyme levels were seen only in less than 10% compared to one-year long study of 142 patients on Tenofovir by Sanchez-Conde M et al 14 which may be due to the nearly 45% prevalence of Hepatitis C in that population.…”

“…Common clinical adverse effects were seen in more proportions in Tenofovir, Lamivudine and Efavirenz regimen considering the fact that there are only 13 Causality Assessment by Naranjo's Scale Causality assessment was done by using both Naranjo's and WHO scale. The assessment by Naranjo's scale showed that out of 178 ADRs 169 (95%) ADR's were possible, 9 (5%) were classified as probable.…”

Structure and quality of outpatient care for people living with an HIV infection

“…Despite the fact that the importance of management of non-HIV comorbidities has been recognized (Chu et al, 2011), no studies measured non-HIV outcomes (e.g., blood pressure, cholesterol, and glucose) and only one measured process outcomes related to comorbidity .…”

“…An initial step in this process is to define what good quality of HIV care is (Hung & Pradel, 2014). Since the role of non-HIV comorbidity is increasing, researchers and health-care providers need to go beyond HIV-related morbidity in the evaluation of health outcomes (Chu et al, 2011).…”

Enfermedad cardiovascular y metabólica en pacientes infectados por el virus de la inmunodeficiencia humana

“…La dislipidemia, la lipodistrofia y la resistencia a la insulina son las principales enfermedades que están presentes en estos pacientes 65 . Dados los procesos fisiopatológicos mencionados, estas enfermedades tienen una íntima relación en su historia natural (Ver Figura 2) por lo cual en la mayoría de los pacientes infectados se presentan de manera simultánea y progresiva La dislipidemia asociada al VIH es un problema que se estima se presenta en un 48% y se asocia con aumento en la incidencia de la enfermedad cardiovascular 66 . Los mecanismos que han intentado explicar este fenómeno incluyen incremento en los niveles de citoquinas (TNF e IL-6), disminución de la depuración de los lípidos, y el aumento de la síntesis hepática de lipoproteína de muy baja densidad 65 .…”