Trends in Nonlipid Cardiovascular Disease Risk Factor Management in the Women's Interagency HIV Study and Association with Adherence to Antiretroviral Therapy

Abstract

Cardiovascular disease (CVD) is increasingly common among women with HIV, but literature on nonlipid CVD risk factor management is lacking. We examined semiannual trends from 2006 to 2014 in hypertension treatment and control (blood pressure <140/90 mmHg), diabetes treatment and control (fasting glucose <130 mg/dL), and smoking quit rates in the Women's Interagency HIV Study. Unadjusted and adjusted Poisson regression models tested time trends and differences between HIV+ and HIV-women. Among antiretroviral therapy (ART) users, we examined the association of ART adherence and virologic suppression with each outcome. We evaluated 1636 HIV+ and 683 HIV-women, with a hypertension prevalence of 40% and 38%, respectively; diabetes prevalence of 21% and 22%; and smoking prevalence of 37% and 48%. Hypertension treatment was higher among HIV+ than HIV-women (77% vs. 67%, p < 0.001) and increased over time with no difference in trend by HIV status. Hypertension control was greater among HIV+ women (56% vs. 43%, p < 0.001) and increased over time among HIV+ but not HIV-women. Diabetes treatment was similar among HIV+ and HIV-women (48% vs. 49%) and increased over time in both groups. Diabetes control was greater among HIV+ women (73% vs. 64%, p = 0.03) and did not change over time. The percent of recent smokers who reported no longer smoking was similar between HIV+ and HIV-women (10% vs. 9%), with no differences over time. Virologic suppression was significantly associated with increased hypertension treatment and greater control. HIV+ women have better control of hypertension and diabetes than HIV-women, but many are still not at target levels.

Suboptimal primary and secondary cardiovascular disease prevention in HIV-positive individuals on antiretroviral therapy

“…Suboptimal cardiovascular risk management has been previously reported both in the general and HIV-positive population. 5 , 7 – 13 , 18 , 19 , 21 – 26 These studies in HIV-positive populations had smaller proportions of individuals with suppressed viraemia on cART and often focused on one aspect of cardiovascular risk management, whereas our study assessed management more comprehensively. Although over 90% of HIV-positive individuals in our study population had suppressed viraemia – and were thus adherent to cART – we found it striking that (effective) use of cardiovascular medication was poor.…”

Cardiovascular disease risk among women living with HIV in North America and Europe

“…A US WIHS study suggested that a higher percentage of WLHIV receive targeted therapeutics for known cardiometabolic risk factors as compared with women without HIV(73). In contrast, a US Partners Healthcare System database study revealed that a lower percentage of WLHIV with heart failure were prescribed standard-of-care therapy as compared with uninfected women with heart failure(9).…”

Epidemiology of ischemic heart disease in HIV

“…In contrast, a study from the Women’s Interagency HIV Study (WIHS) cohort showed HIV-infected women to have better controlled hypertension and diabetes compared with HIV-uninfected women. 90 …”