CLINICAL CORNER

by Jeffrey T. Kirchner, DO, AAHIVS, AAHIVM Chief Medical Officer

May 9, 2019


Featured Literature:
Frazier EL et al. Differences by Sex in Cardiovascular Comorbid Conditions Among Older Adults (Aged 50–64 or ≥65 Years) Receiving Care for Human Immunodeficiency Virus

Clinical Infectious Diseases, ciz126, https://doi.org/10.1093/cid/ciz126. Published May 3, 2019.

It is currently estimated that 46% of persons living with HIV (PLWH) in the U.S. are > 50 years of age. Numerous studies have shown an increased risk for cardiovascular disease (CVD), heart failure and stroke in this population. The prevalence of cardiovascular comorbid conditions among (PLWH) aged 50–64 years has not been extensively studied and there is even less data for those ≥65 years of age. This study used data from the CDC’s Medical Monitoring Project which is a national cross-sectional sampling of HIV-infected adults. They examined characteristics of the two age groups noted above and also looked at differences based on sex. Comorbid conditions for this study included overweight/obesity (BMI > 25), total cholesterol ≥200 mg/dL, diabetes mellitus, or hypertension. The authors calculated weighted-prevalence estimates and used logistic regression to calculate prevalence differences, (including by sex) for cardiovascular comorbid conditions. The sample size was 7436 with 75% men and 25% women. Approximately 90% were aged 50–64 years and 10% aged ≥65 years. The majority had been diagnosed with HIV infection for at least 10 years, 94% were on ART, and 70% had undetectable viral loads. After adjustment for sociodemographic and behavioral factors, women aged 50–64 years were more likely than men to be obese, hypertensive, or have high cholesterol. Those women ≥65 years had higher prevalence of diabetes mellitus and high total cholesterol levels than men in the age range and nearly 50% of older women compared to 28% of men had ­> 3 CVD comorbidities. The authors conclude that CVD risk-factors are highly prevalent among older HIV-infected persons in care with women affected more than men, especially in those over age 65. Closer monitoring and risk-reduction strategies for CVD comorbid conditions are warranted for older HIV-infected persons, especially women.

Commentary: This study adds to our knowledge of the prevalence of CVD risk factors in the aging HIV population which contribute to but are not the sole reason for the higher prevalence of heart disease and stroke in PLWH. Aggressive screening and appropriate therapeutic interventions (e.g. statin therapy, blood pressure lowering) for men and women are an important aspect of the long-term care of PLWH. Readers are referred to the 2019 Fundamentals of HIV Medicine chapter on Cardiovascular Disease by Dr. David Wohl and myself that discusses current diagnosis and guideline-based management of CVD and associated risk factors in HIV-infected patients.

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