Improved Cardiovascular Treatments Needed for Patients With HIV

Patients who are HIV positive often slip through the cracks when it comes to heart health, according to new research.

A study from the University of California, Los Angeles (UCLA), found doctors were less likely to prescribe common cardiovascular prevention and intervention therapies to HIV-positive patients when compared to the general population.

The study is based on data from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey from 2006 to 2013. The data covered patients ages 40—79, some of whom were HIV positive, some of whom weren’t. Patients with liver disease and hepatitis were excluded.

The researchers found that while 13.8% of HIV-negative patients were put on an aspirin/antiplatelet therapy for cardiovascular disease prevention, only 5.1% of HIV-positive patients were prescribed the same.

Likewise, among patients with diabetes, cardiovascular disease, or dyslipidemia, HIV-negative patients were given statin therapy in 35.8% of their doctor visits, while HIV-positive patients received the therapy in only 23.6% of visits.

Joseph A. Ladapo, MD, PhD, the study’s lead author and an associate professor at UCLA’s David Geffen School of Medicine, told MD Magazine one reason for the discrepancy could be a change in the life expectancy of HIV-positive patients as a result of new therapies.

“A big part of the issue is the epidemiological shift in patients with HIV: they are living longer in wealthy countries like the US and [are] therefore more likely to develop cardiovascular disease,” he said.

Another reason for the gap could be a natural tendency to focus more on what’s perceived to be the more serious condition.

“There is a tremendous amount of attention on getting patients to adhere to antiretroviral therapy,” Ladapo said. “This is important of course because it is life-saving. For this reason, though, I think that other primary care may not always get the same attention.”

Additionally, there are also likely concerns among physicians about drug interactions, but Ladapo noted, “there is actually good evidence for safety and efficacy of certain statins in patients with HIV (for example, rosuvastatin and pravastatin).”

The study found smaller statistical differences in rates of antihypertensive medication therapy, diet and exercise counseling, and smoking cessation therapy and counseling depending on HIV status. In all of those cases, HIV-positive patients received the treatment less often, though the gap between HIV-positive and -negative patients was in the single digits in each case.

Ladapo put the study in context by noting that HIV-positive patients are not the only category of people who appear to receive treatment at lower rates than the general public. However, now that there is clear evidence regarding cardiovascular care and HIV, Ladapo said there are a number of easy steps physicians can take to try and close the gap.

“Some things that might help include electronic health record-based interventions that provide defaults for treatment (for example, automatic calculation of cardiovascular disease risk and automatic prompting for a statin prescription when the risk becomes significant) and economic incentives, such as targeted reimbursement for preventive cardiovascular care,” he said.

The study, titled "Disparities in the Quality of Cardiovascular Care Between HIV‐Infected Versus HIV‐Uninfected Adults in the United States: A Cross‐Sectional Study," was published last month in the Journal of the American Heart Association.

This article was originally published by MD Magazine.