Patient characteristics and costs associated with dyslipidaemia and related conditions in HIV‐infected patients: a retrospective cohort study

Richter, Anke; Pladevall, Manel; Manjunath, Ranjani; Lafata, JE; Xi, Hugo; Simpkins, Janine; Brar, Indira; Markowitz, Norman; Iloeje, Uchenna H.; Irish, William

doi:10.1111/j.1468-1293.2005.00269.x

Cited by 28 publications

(24 citation statements)

References 36 publications

(33 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the D:A:D study, rates of dyslipidaemia remained relatively stable for each calendar year between 2000 and 2006, 5 while data from the Veteran's Affair study reported dyslipidaemia to be more common among older HIV-positive patients who are also male and of white ethnicity. 49 As this population is living longer, HIV-positive patients will be receiving cART for much longer, and the independent effect of aging on dyslipidaemia will continue to be confounded by the direct effect of ART, other CVD risk factors and increases in the use of lipid-lowering medication.…”

Section: Traditional Risk Factorsmentioning

confidence: 99%

HIV infection, aging and cardiovascular disease: epidemiology and prevention

Petoumenos

Worm

2011

Sex. Health

View full text Add to dashboard Cite

Abstract. In the developed world, HIV infection is now well managed with very effective and less toxic antiretroviral treatment. HIV-positive patients therefore are living longer, but are now faced by challenges associated with aging. Several non-AIDS associated morbidities are increased in this population, including cardiovascular disease (CVD). It is suggested that CVD occurs earlier among HIV-positive patients compared with HIV-negative patients, and at a higher rate. Several factors have been proposed to contribute to this. First, the traditional CVD risk factors are highly prevalent in this population. High rates of smoking, dyslipidaemia and a family history of CVD have been reported. This population is also aging, with estimates of more than 25% of HIV-positive patients in the developed world being over the age of 50. Antiretroviral treatment, both through its effect on lipids and through other, sometimes less well understood, mechanisms, has been linked to increased CVD risk. HIV infection, especially untreated, is a further contributing factor to increased CVD risk in HIV-positive patients. As the HIV-positive population continues to age, the risk of CVD will continue to increase. Guidelines for the management and prevention of CVD risk have been developed, and are largely modelled on those used in the general population. However, the data currently suggest that these interventions, such as the use of lipid-lowering medications and smoking cessation programs, remain quite low. A better understanding the mechanisms of CVD risk in this aging population and further efforts in improving uptake of prevention strategies will remain an important research area.

show abstract

Section: Traditional Risk Factorsmentioning

confidence: 99%

HIV infection, aging and cardiovascular disease: epidemiology and prevention

Petoumenos

Worm

2011

Sex. Health

View full text Add to dashboard Cite

show abstract

“…In Malaysia there were more than 80 000 [52 000-120 000] On the other hand, ART (Antiretroviral Therapy) can cause a variety of side effects, some of them adversely affecting the nutritional status of PLHIV (WHO, 2007). Changes in body composition and metabolic complications such as dyslipidemia, insulin resistance Richter et al, 2005;Hansen et al, 2009) and increased rate of cardiovascular disease (CVD) (Depairon et al, 2001;Baum et al, 2006;Sankatsing et al, 2009) are the most commonly quoted adverse nutritional effects on patients receiving highly active antiretroviral therapy (HAART). Related to this, abdominal obesity as a typically morphological abnormality has been observed among both HIV-positive men and women (Galli et al, 2003;Jaime et al, 2006) in many countries where HAART has been available for a long time.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Abdominal Obesity among HIV-infected Adults on Antiretroviral Therapy in Malaysia

Hejazi¹,

Lee²,

Lin³

et al. 2010

GJHS

View full text Add to dashboard Cite

Abdominal or central obesity is a common morphological alteration among HIV-infected subjects on antiretroviral treatment. There is concern that this condition places the subjects at risk of cardiovascular disease. This is a cross-sectional study of 334, HIV-infected adult subjects on antiretroviral therapy at a public hospital in Malaysia. It was aimed at determining the association between nutritional factors and abdominal obesity among PLHIV receiving antiretroviral treatment. Abdominal obesity was prevalent in 36.5% of the respondents. Respondents with abdominal obesity were significantly (p<0.05) older in age, had significantly higher blood triglycerides, fasting plasma glucose, lower HDL-cholesterol, higher BMI at the start of medication and also at the time of the study, bigger waist circumference, higher waist hip ratio, body fat mass, systolic and diastolic blood pressure. They also had lower mean CD4 cell count at start of medication and body lean mass than those without abdominal obesity. After adjusting for the covariates, a significantly higher risk of abdominal obesity was observed in those who were older (adjusted OR=1.053, CI=1.012-1.095), had higher fasting plasma glucose (adjusted OR=1.189, CI=1.014-1.394), higher BMI at the time of study (adjusted OR=1.426,. Being Malay was a protective factor (adjusted OR=0.264, CI=00.102-0.685) for abdominal obesity. These results suggest that care of the HIV-infected population must include intervention to address abdominal obesity in order to provide better quality of life.

show abstract

“…Conversely, a growing body of literature shows that HCV infection has been associated with lower rates of HIV-and highly active antiretroviral therapy (HAART)-associated dyslipidaemias among HIVinfected patients, with lower mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) [10,[15][16][17][18][19][20][21]. Also, patients with chronic HCV monoinfection have lower rates of lipid abnormalities than age-and sex-matched healthy subjects [22], and LDL-C concentrations were inversely correlated with the severity of liver disease [23].…”

Section: Introductionmentioning

confidence: 99%

“…Among HIV-infected patients, HCV coinfection has been shown to be associated with higher rates of several metabolic complications including lipodystrophy [10], hepatic steatosis and nonalcoholic fatty liver disease (NAFLD) [11], metabolic syndrome [12], glucose intolerance and diabetes [13,14]. Conversely, a growing body of literature shows that HCV infection has been associated with lower rates of HIV-and highly active antiretroviral therapy (HAART)-associated dyslipidaemias among HIVinfected patients, with lower mean total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglyceride (TG) [10,[15][16][17][18][19][20][21]. Also, patients with chronic HCV monoinfection have lower rates of lipid abnormalities than age-and sex-matched healthy subjects [22], and LDL-C concentrations were inversely correlated with the severity of liver disease [23].…”

mentioning

confidence: 99%

Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV‐infected patients

et al. 2010

View full text Add to dashboard Cite

BackgroundAmong HIV-infected patients, hepatitis C virus (HCV) coinfection is associated with lower cholesterol levels, but it remains unclear how it affects cardiovascular outcomes. MethodsWe performed logistic regression to evaluate acute myocardial infarction (AMI) and cerebrovascular disease (CVD) events by HCV status among HIV-infected US veterans in the highly active antiretroviral therapy (HAART) era (1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004). We then performed survival analyses to evaluate incident AMI and CVD, exploring antiretroviral therapy (ART) as a time-dependent variable. ResultsA total of 19 424 HIV-infected patients [31.6% of whom were HCV-coinfected (HIV/HCV)] contributed 76 376 patient-years of follow-up. HCV coinfection was associated with lower rates of hypercholesterolaemia (18.0% in HIV/HCV vs. 30.7% in HIV-only patients; Po0.001), but higher rates of hypertension (43.8% vs. 35.6%; Po0.0001), type 2 diabetes mellitus (16.2% vs. 11.1%; Po0.0001) and smoking (36.7% vs. 24.7%; P 5 0.009). Rates of AMI and CVD were significantly higher among HIV/HCV than HIV-only patients: 4.19 vs. 3.36 events/1000 patient-years, respectively (Po0.001), for AMI; and 12.47 vs. 11.12 events/1000 patient-years, respectively (Po0.001), for CVD. When analyses were controlled for diabetes mellitus, hypertension, age and duration of ART, hazard ratios (HRs) among those with HIV/HCV (vs. HIV only) were 1.25 [95% confidence interval (CI) 0.98-1.61; P 5 0.072] for AMI and 1.20 (CI 1.04-1.38; P 5 0.013) for CVD. Hypertension (HR 2.05; Po0.001), greater age (HR 1.79; Po0.001) and longer duration (cumulative years) of antiretroviral use (HR 1.12; P 5 0.0411) were also associated with increased risk of AMI in the adjusted model. ConclusionsIn the HAART era, HCV coinfection was associated with a significantly increased risk of CVD and a trend towards an increased risk of AMI among HIV-infected patients.Keywords: acute myocardial infarction, cerebrovascular disease, hepatitis C, highly active antiretroviral therapy, incidence IntroductionThe increase in overall survival of HIV-infected patients has been associated with a shift in underlying cause of death, with decreased representation of AIDS-related causes and increased representation of non-AIDS-related deaths, which rose by 33% in one recent series [1]. The most prevalent non-AIDS-related causes of morbidity and mortality are chronic liver disease, metabolic complications including cardiovascular disease, and non-AIDSdefining malignancies [1][2][3].It has been estimated that 15 to 30% of all HIV-infected persons are also infected with the hepatitis C virus (HCV) [4,5]. The percentage of HIV-infected patients coinfected with HCV was found to vary significantly in previous studies depending on risk factors, from as low as 4% among HIV-infected non-drug users to as high as 89% among HIV-infected injecting drug users (IDUs) [4][5][6][7]. It is now well established that there is a significantly elevated risk of severe liver disease in persons who are coinfected D...

show abstract

Patient characteristics and costs associated with dyslipidaemia and related conditions in HIV‐infected patients: a retrospective cohort study

Cited by 28 publications

References 36 publications

HIV infection, aging and cardiovascular disease: epidemiology and prevention

HIV infection, aging and cardiovascular disease: epidemiology and prevention

Factors Associated with Abdominal Obesity among HIV-infected Adults on Antiretroviral Therapy in Malaysia

Hepatitis C virus coinfection and the risk of cardiovascular disease among HIV‐infected patients

Contact Info

Product

Resources

About