Provider compliance with guidelines for management of cardiovascular risk in HIV-infected patients

Kenneth A Lichtenstein, Carl Armon, Kate Buchacz, Joan S Chmiel, Kern Buckner, Ellen Tedaldi, Kathleen Wood, Scott D Holmberg, John T Brooks, HOPS Investigators, John T Brooks, Kate Buchacz, Marcus D Durham, T B Prevention, Kathleen C Wood, Rose K Baker, James T Richardson, Darlene Hankerson, Rachel Debes, Carl Armon, Bonnie Dean, Frank J Palella, Joan S Chmiel, Carolyn Studney, Onyinye Enyia, Tiffany Murphy, Kenneth A Lichtenstein, Cheryl Stewart, John Hammer, Kenneth S Greenberg, Barbara Widick, Joslyn D Axinn, Bienvenido G Yangco, Kalliope Halkias, Doug Ward, Troy Thomas, Rob Grant, Jack Fuhrer, Linda Ording-Bauer, Rita Kelly, Jane Esteves, Ellen M Tedaldi, Ramona A Christian, Faye Ruley, Dania Beadle, Princess Graham, Richard M Novak, Andrea Wendrow, Renata Smith, Benjamin Young, Barb Widick, Joslyn Axinn, Kenneth A Lichtenstein, Carl Armon, Kate Buchacz, Joan S Chmiel, Kern Buckner, Ellen Tedaldi, Kathleen Wood, Scott D Holmberg, John T Brooks, HOPS Investigators, John T Brooks, Kate Buchacz, Marcus D Durham, T B Prevention, Kathleen C Wood, Rose K Baker, James T Richardson, Darlene Hankerson, Rachel Debes, Carl Armon, Bonnie Dean, Frank J Palella, Joan S Chmiel, Carolyn Studney, Onyinye Enyia, Tiffany Murphy, Kenneth A Lichtenstein, Cheryl Stewart, John Hammer, Kenneth S Greenberg, Barbara Widick, Joslyn D Axinn, Bienvenido G Yangco, Kalliope Halkias, Doug Ward, Troy Thomas, Rob Grant, Jack Fuhrer, Linda Ording-Bauer, Rita Kelly, Jane Esteves, Ellen M Tedaldi, Ramona A Christian, Faye Ruley, Dania Beadle, Princess Graham, Richard M Novak, Andrea Wendrow, Renata Smith, Benjamin Young, Barb Widick, Joslyn Axinn

Abstract

Introduction: Compliance with National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines has been shown to significantly reduce incident cardiovascular events. We investigated physicians' compliance with NCEP guidelines to reduce cardiovascular disease (CVD) risk in a population infected with HIV.

Methods: We analyzed HIV Outpatient Study (HOPS) data, following eligible patients from January 1, 2002, or first HOPS visit thereafter to calculate 10-year cardiovascular risk (10yCVR), until September 30, 2009, death, or last office visit. We categorized participants into four 10yCVR strata, according to guidelines determined by NCEP, the Infectious Disease Society of America, and the Adult AIDS Clinical Trials Group. We calculated percentages of patients treated for dyslipidemia and hypertension, calculated percentages of patients who achieved recommended goals, and categorized them by 10yCVR stratum.

Results: Of 2,005 patients analyzed, 33.7% had fewer than 2 CVD risk factors. For patients who had 2 or more risk factors, 10yCVR was less than 10% for 28.2%, 10% to 20% for 18.2%, and higher than 20% for 20.0% of patients. Of patients eligible for treatment, 81% to 87% were treated for elevated low-density lipoprotein cholesterol/non-high-density lipoprotein cholesterol (LDL-C/non-HDL-C), 2% to 11% were treated for low HDL-C, 56% to 91% were treated for high triglycerides, and 46% to 69% were treated for hypertension. Patients in higher 10yCVR categories were less likely to meet treatment goals than patients in lower 10yCVR categories.

Conclusion: At least one-fifth of contemporary HOPS patients have a 10yCVR higher than 20%, yet a large percentage of at-risk patients who were eligible for pharmacologic treatment did not receive recommended interventions and did not reach recommended treatment goals. Opportunities exist for CVD prevention in the HIV-infected population.

Figures

Figure 1
Figure 1
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) guidelines, by sex, the HIV Outpatient Study, January 2002–September 2009. Error bars indicate 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]
Figure 2
Figure 2
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) Guidelines, by race/ethnicity, the HIV Outpatient Study, January 2002–September 2009. Error bars represent 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]
Figure 3
Figure 3
Percentage of patients with condition treated per National Cholesterol Education Program Adult Treatment Panel III (NCEP) Guidelines, by payer, the HIV Outpatient Study, January 2002–September 2009. Error bars represent 95% confidence intervals. Abbreviations: LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol. [Table: see text]

References

    1. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004;350(15):1495-504. Erratum in: N Engl J Med 2006;354(7):778.
    1. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001;285(19):2486–97. 10.1001/jama.285.19.2486
    1. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial [summary for patients in Curr Cardiol Rep 2002;4(6):486-7]. Lancet 2002;360(9326):7–22. 10.1016/S0140-6736(02)09327-3
    1. Sever PS, Dahlöf B, Poulter NR, Wedel H, Beevers G, Caulfield M, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial–Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003;361(9364):1149–58. 10.1016/S0140-6736(03)12948-0
    1. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360(9346):1623–30. 10.1016/S0140-6736(02)11600-X
    1. Dubé MP, Stein JH, Aberg JA, Fichtenbaum CJ, Gerber JG, Tashima KT, et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis 2003;37(5):613–27. 10.1086/378131
    1. Gallant JE, Staszewski S, Pozniak AL, DeJesus E, Suleiman JM, Miller MD, et al. Efficacy and safety of tenofovir DF vs stavuine in combination therapy in antiretroviral-naive patients: a 3-year randomized trial. JAMA 2004;292(2):191–201. 10.1001/jama.292.2.191
    1. Johnson M, Grinsztejn B, Rodriguez C, Coco J, DeJesus E, Lazzarin A, et al. Atazanavir plus ritonavir or saquinavir and lopinavir/ritonavir in patients experiencing multiple virological failures. AIDS 2005;19(7):685–94. 10.1097/01.aids.0000166091.39317.99
    1. Mills AM, Nelson M, Jayaweera D, Ruxrungtham K, Cassetti I, Girard PM, et al. Once-daily darunavir/ritonavir vs. lopinavir/ritonavir in treatment-naive, HIV-1-infected patients: 96-week analysis. AIDS 2009;23(13):1679–88. 10.1097/QAD.0b013e32832d7350
    1. Molina JM, Andrade-Villanueva J, Echevarria J, Chetchotisakd P, Corral J, David N, et al. Once-daily atazanavir/ritonavir compared with twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive HIV-1-infected patients: 96-week efficacy and safety results of the CASTLE Study. J Acquir Immune Defic Syndr 2010;53(3):323–32. 10.1097/QAI.0b013e3181c990bf
    1. Podzamczer D, Ferrer E, Sanchez P, Gatell JM, Crespo M, Fisac C, et al. Less lipoatrophy and better lipid profile with abacavir as compared to stavudine: 96-week results of a randomized study. J Acquir Immune Defic Syndr 2007;44(2):139–47. 10.1097/QAI.0b013e31802bf122
    1. Smith KY, Weinberg WG, DeJesus E, Fischl MA, Liao Q, Ross LL, et al. Fosamprenavir or atazanavir once daily boosted with ritonavir 100 mg, plus tenofovir/emtricitabine, for the inital treatment of HIV infection: 48-week results of ALERT. AIDS Res Ther 2008;5(5):1–10.
    1. van Leth F, Phanuphak P, Stroes E, Gazzard B, Cahn P, Raffi F, et al. Nevirapine and efavirenz elicit different changes in lipid profiles in antiretroviral-therapy-naive patients infected with HIV-1 . PLoS Med 2004;1(1):e19. Erratum in: PLoS Med 2004;1(3):e73. 10.1371/journal.pmed.0010019
    1. Walmsley S, Avihingsanon A, Slim J, Ward DJ, Ruxrungtham K, Brunetta J, et al. Gemini: a noninferiority study of saquinavir/ritonavir versus lopinavir/ritonavir as initial HIV-1 therapy in adults. J Acquir Immune Defic Syndr 2009;50(4):367–74. 10.1097/QAI.0b013e318198a815
    1. Dean AG, Sullivan KM, Soe MM. OpenEpi: open source epidemiologic statistics for public health, version 2.3.1. . Accessed September 4, 2012.
    1. Currier JS, Kendall MA, Zackin R, Henry WK, Alston-Smith B, Torriani FJ, et al. Carotid artery intima-media thickness and HIV infection: traditional risk factors overshadow impact of protease inhibitor exposure. AIDS 2005;10;19(9):927-33.
    1. Henry K, Melroe H, Huebsch J, Hermundson J, Levine C, Swensen L, et al. Severe premature coronary artery disease with protease inhibitors. Lancet 1998;351(9112):1328. 10.1016/S0140-6736(05)79053-X
    1. Kaplan RC, Kingsley LA, Sharrett AR, Li X, Lazar J, Tien PC, et al. Ten-year predicted coronary heart disease risk in HIV-infected men and women. Clin Infect Dis 2007;45(8):1074–81. 10.1086/521935
    1. Lai S, Fishman EK, Lai H, Moore R, Cofranchesco JJ Jr, Pannu H, et al. Long-term cocaine use and antiretroviral therapy are associated with silent coronary artery disease in African Americans with HIV infection who have no cardiovascular symptoms. Clin Infect Dis 2008;46:600–10. 10.1086/526782
    1. Savès M, Chène G, Ducimetière P, Leport C, Le Moal G, Amouyel P, et al. Risk factors for coronary heart disease in patients treated for human immunodeficiency virus infection compared with the general population. Clin Infect Dis 2003;37(2):292–8. 10.1086/375844
    1. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab 2007;92(7):2506–12. 10.1210/jc.2006-2190
    1. Wand H, Calmy A, Carey DL, Samaras K, Carr A, Law MG, et al. Metabolic syndrome, cardiovascular disease and type 2 diabetes mellitus after initiation of antiretroviral therapy in HIV infection. AIDS 2007;21(18):2445–53. 10.1097/QAD.0b013e3282efad32
    1. Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ, et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998;12(7):F51–8. 10.1097/00002030-199807000-00003
    1. Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidaemia, and diabetes mellitus: a cohort study. Lancet 1999;353(9170):2093–9. 10.1016/S0140-6736(98)08468-2
    1. Eron J, Yeni P, Gathe J Jr, Estrada V, DeJesus E, Staszewski S, et al. The KLEAN study of fosamprenavir-ritonavir versus lopinavir-ritonavir, each in combination with abacavir-lamivudine, for initial treatment of HIV infection over 48 weeks: a randomised non-inferiority trial. Lancet 2006;368(9534):476–82. 10.1016/S0140-6736(06)69155-1
    1. Gutiérrez F, Padilla S, Navarro A, Masiá M, Hernández I, Ramos J, et al. Lopinavir plasma concentrations and changes in lipid levels during salvage therapy with lopinavir/ritonavir-containing regimens. J Acquir Immune Defic Syndr 2003;33(5):594–600. 10.1097/00126334-200308150-00007
    1. Johnson M, Grinsztejn B, Rodriguez C, Coco J, DeJesus E, Lazzarin A, et al. Atazanavir plus ritonavir or saquinavir, and lopinavir/ritonavir in patients experiencing multiple virological failures [republished from AIDS 2005;19(2):153-62]. AIDS 2005;19(7):685–94. 10.1097/01.aids.0000166091.39317.99
    1. Martínez E, Domingo P, Galindo MJ, Milinkovic A, Arroyo JA, Baldovi F, et al. Risk of metabolic abnormalities in patients infected with HIV receiving antiretroviral therapy that contains lopinavir-ritonavir. Clin Infect Dis 2004;38(7):1017–23. 10.1086/382531
    1. Mary-Krause M, Cotte L, Simon A, Partisani M, Costagliola D; Clinical Epidemiology Group from the French Hospital Database. Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men. AIDS 2003;17(17):2479–86. 10.1097/00002030-200311210-00010
    1. Montes ML, Pulido F, Barros C, Condes E, Rubio R, Cepeda C, et al. Lipid disorders in antiretroviral-naive patients treated with lopinavir/ritonavir-based HAART: frequency, characterization and risk factors. J Antimicrob Chemother 2005;55(5):800–4. 10.1093/jac/dki063
    1. Mulligan K, Grunfeld C, Tai VW, Algren H, Pang M, Chernoff DN, et al. Hyperlipidemia and insulin resistance are induced by protease inhibitors independent of changes in body composition in patients with HIV infection. J Acquir Immune Defic Syndr 2000;23(1):35–43.
    1. Simpson KN, Jones WJ, Rajagopalan R, Dietz B. Cost effectiveness of lopinavir/ritonavir tablets compared with atazanavir plus ritonavir in antiretroviral-experienced patients in the UK, France, Italy and Spain. Clin Drug Investig 2007;27(12):807–17. 10.2165/00044011-200727120-00002
    1. Riddler SA, Smit E, Cole SR, Li R, Chmiel JS, Dobs A, et al. Impact of HIV infection and HAART on serum lipids in men. JAMA 2003;289(22):2978–82. 10.1001/jama.289.22.2978
    1. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High-density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med 1977;62(5):707–14. 10.1016/0002-9343(77)90874-9
    1. Jacobson TA, Case CC, Roberts S, Buckley A, Murtaugh KM, Sung JC, et al. Characteristics of US adults with the metabolic syndrome and therapeutic implications. Diabetes Obes Metab 2004;6(5):353–62. 10.1111/j.1462-8902.2004.00354.x
    1. Grundy SM, Cleeman JI, Merz CN, Brewer HP Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. J Am Coll Cardiol 2004;44(3):720–32. 10.1016/j.jacc.2004.07.001
    1. Persell SD, Lloyd-Jones DM, Baker DW. Implications of changing national cholesterol education program goals for the treatment and control of hypercholesterolemia. J Gen Intern Med 2006;21(2):171–6.
    1. Data Collection on Adverse Events of Anti-HIV Drugs Study Group; Sabin CA, d’Arminio Monforte A, Friis-Moller N, Weber R, El-Sadr WM, Reiss P, et al.. Changes over time in risk factors for cardiovascular disease and use of lipid-lowering drugs in HIV-infected individuals and impact on myocardial infarction. Clin Infect Dis 2008;46(7):1101–10. 10.1086/528862
    1. Reinsch N, Neuhaus K, Esser S, Potthoff A, Hower M, Mostardt S, et al. Are HIV patients undertreated? Cardiovascular risk factors in HIV: results of the HIV-HEART study. Eur J Prev Cardiol 2012;19(2):267–74. 10.1177/1741826711398431
    1. D:A:D Study Group; Sabin CA, Worm SW, Weber R, Reiss P, El-Sadr W, Dabis F, et al.. Use of nucleoside reverse transcriptase inhibitors and risk of myocardial infarction in HIV-infected patients enrolled in the D:A:D study: a multi-cohort collaboration. Lancet 2008;371(9622);1417-26. 10.1016/S0140-6736(08)60423-7
    1. Sobieszczyk ME, Hoover DR, Anastos K, Mulligan K, Tan T, Shi Q, et al. Prevalence and predictors of metabolic syndrome among HIV-infected and HIV-uninfected women in the Women’s Interagency HIV Study. J Acquir Immune Defic Syndr 2008;48(3):272–80. 10.1097/QAI.0b013e31817af461

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