Skip to main content

Advertisement

Log in

The Association Between the Receipt of Lipid Lowering Therapy and HIV Status Among Veterans Who Met NCEP/ATP III Criteria for the Receipt of Lipid Lowering Medication

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

ABSTRACT

OBJECTIVE

To examine the association between HIV infection status and the receipt of lipid lowering therapy based on National Cholesterol Education Program/Adult Treatment Panel (NCEP/ATP III) guidelines and to assess whether HIV viral load and hepatitis C (HCV) status alters that association.

PARTICIPANTS AND DESIGN

A cross-sectional analysis of survey, laboratory, and pharmacy data from 1,577 male participants (59% HIV infected) of the Veterans Aging Cohort Five-Site Study, a prospective observational cohort of U.S. veterans with and without HIV infection.

MEASUREMENTS

Receipt of lipid lowering therapy obtained from the VA pharmacy benefits management system was the main outcome.

RESULTS

The prevalence of lipid lowering therapy among HIV-infected and HIV-uninfected veterans was 15.4% vs. 37.9%, respectively, p < 0.01. Among veterans who met NCEP/ATP III criteria for lipid lowering therapy, HIV-infected veterans had a significantly lower prevalence for the receipt of lipid lowering therapy (adjusted odds ratio (OR) = 0.43, 95% confidence interval (C.I.) 0.28–0.67) as compared with HIV-uninfected veterans. Among HIV-infected veterans, log HIV viral load (adjusted OR = 0.57, 95% CI, 0.41–0.81) and HIV-HCV co-infection (adjusted OR = 0.31, 95% CI = 0.13–0.75) were negatively associated with receipt of lipid lowering therapy. Exposure to HAART was not associated with receipt of lipid lowering therapy.

CONCLUSIONS

Among those who met NCEP/ATP III criteria for lipid lowering therapy, HIV-infected veterans, particularly those with high HIV viral loads and HCV co-infection, were significantly less likely to receive lipid lowering therapy. This may be a modifiable mediator of cardiovascular disease among HIV-infected individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased Acute Myocardial Infarction Rates and Cardiovascular Risk Factors Among Patients with HIV Disease. J Clin Endocrinol Metab 2007.

  2. Obel N, Thomsen HF, Kronborg G, et al. Ischemic heart disease in HIV-infected and HIV-uninfected individuals: a population-based cohort study. Clin Infect Dis. 2007;44(12):1625–31.

    Article  PubMed  Google Scholar 

  3. Hadigan C, Meigs JB, Corcoran C, et al. Metabolic abnormalities and cardiovascular disease risk factors in adults with human immunodeficiency virus infection and lipodystrophy. Clin Infect Dis. 2001;32(1):130–9.

    Article  PubMed  CAS  Google Scholar 

  4. Friis-Moller N, Weber R, Reiss P, et al. Cardiovascular disease risk factors in HIV patients—association with antiretroviral therapy. Results from the DAD study. Aids. 2003;17(8):1179–93.

    Article  PubMed  Google Scholar 

  5. Friis-Moller N, Sabin CA, Weber R, et al. Combination antiretroviral therapy and the risk of myocardial infarction. N Engl J Med. 2003;349(21):1993–2003.

    Article  PubMed  Google Scholar 

  6. Friis-Moller N, Reiss P, Sabin CA, et al. Class of antiretroviral drugs and the risk of myocardial infarction. N Engl J Med. 2007;356(17):1723–35.

    Article  PubMed  Google Scholar 

  7. 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.

    Google Scholar 

  8. Dube MP, Stein JH, Aberg JA, 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.

    Article  PubMed  Google Scholar 

  9. Schambelan M, Benson CA, Carr A, et al. Management of metabolic complications associated with antiretroviral therapy for HIV-1 infection: recommendations of an International AIDS Society-USA panel. J Acquir Immune Defic Syndr (1999). 2002;31(3):257–75.

    Google Scholar 

  10. Justice AC, Lasky E, McGinnis KA, et al. Medical disease and alcohol use among veterans with human immunodeficiency infection: A comparison of disease measurement strategies. Med care. 2006;44(8 Suppl 2):S52–60.

    Article  PubMed  Google Scholar 

  11. Mary-Krause M, Cotte L, Simon A, Partisani M, Costagliola D. Increased risk of myocardial infarction with duration of protease inhibitor therapy in HIV-infected men. AIDS. 2003;17(17):2479–86.

    Article  PubMed  Google Scholar 

  12. Currier JS, Taylor A, Boyd F, et al. Coronary heart disease in HIV-infected individuals. J Acquir Immune Defic Syndr. 2003;33(4):506–12.

    PubMed  Google Scholar 

  13. Holmberg SD, Moorman AC, Greenberg AE. Trends in rates of myocardial infarction among patients with HIV. N Engl J Med. 2004;350(7):730–2. author reply -2.

    Article  PubMed  CAS  Google Scholar 

  14. Freiberg MS, Cheng DM, Kraemer KL, Saitz R, Kuller LH, Samet JH. The association between hepatitis C infection and prevalent cardiovascular disease among HIV-infected individuals. AIDS. 2007;21(2):193–7.

    Article  PubMed  Google Scholar 

  15. Gardner LI, Klein RS, Szczech LA, et al. Rates and risk factors for condition-specific hospitalizations in HIV-infected and uninfected women. J Acquir Immune Defic Syndr. 2003;34(3):320–30.

    Article  PubMed  Google Scholar 

  16. Justice AC, Dombrowski E, Conigliaro J, et al. Veterans Aging Cohort Study (VACS): Overview and description. Med care. 2006;44(8 Suppl 2):S13–24.

    Article  PubMed  Google Scholar 

  17. Kazis LE. Health Status and Outcomes of Veterans: Physical and Mental Component Summary Scores Veterans SF-36. Bedford, MA: Department of Veterans Affairs; 2000 May.

    Google Scholar 

  18. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction (Abingdon, England) 1993;88(6):791–804.

  19. Gavin DR, Ross HE, Skinner HA. Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. Br J Addict. 1989;84(3):301–7.

    Article  PubMed  CAS  Google Scholar 

  20. Kessler RC, Wittchen H-U, Abelson JM, et al. Methodological studies of the Composite International Diagnostic Interview (CIDI) in the US national comorbidity survey (NCS). Int J Methods Psychiatr Res. 1998;7(1):33–55.

    Article  Google Scholar 

  21. Kazis LE, Miller DR, Clark J, et al. Health-related quality of life in patients served by the Department of Veterans Affairs: results from the Veterans Health Study. Arch Intern Med. 1998;158(6):626–32.

    Article  PubMed  CAS  Google Scholar 

  22. Davidson MB, Schriger DL, Peters AL, Lorber B. Relationship between fasting plasma glucose and glycosylated hemoglobin: potential for false-positive diagnoses of type 2 diabetes using new diagnostic criteria. JAMA. 1999;281(13):1203–10.

    Article  PubMed  CAS  Google Scholar 

  23. Diggle PJ, Liang KY, Zeger SL. Analysis of longitudinal data. Oxford: Oxford Science; 1994.

    Google Scholar 

  24. Shepherd J, Cobbe SM, Ford I, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995;333(20):1301–7.

    Article  PubMed  CAS  Google Scholar 

  25. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344(8934):1383–9.

  26. Periard D, Telenti A, Sudre P, et al. Atherogenic dyslipidemia in HIV-infected individuals treated with protease inhibitors. The Swiss HIV Cohort Study. Circulation. 1999;100(7):700–5.

    PubMed  CAS  Google Scholar 

  27. Sullivan AK, Nelson MR. Marked hyperlipidaemia on ritonavir therapy. AIDS (London, England). 1997;11(7):938–9.

    CAS  Google Scholar 

  28. Illoeje US WY, Kawabita H. Use of lipid lowering therapy among HIV patients on antiretroviral therapy: a 5 year time trend analysis (June 1996-June 2000). In: American Society for Microbiology. San Diego California; 2002.

  29. Klein D, Hurley LB, Quesenberry CP Jr., Sidney S. Do protease inhibitors increase the risk for coronary heart disease in patients with HIV-1 infection? J Acquir Immune Defic Syndr. 2002;30(5):471–7.

    PubMed  CAS  Google Scholar 

  30. El-Sadr WM, Lundgren JD, Neaton JD, et al. CD4+ count-guided interruption of antiretroviral treatment. N Engl J med. 2006;355(22):2283–96.

    Article  PubMed  CAS  Google Scholar 

  31. Fukui M, Kitagawa Y, Nakamura N, Yoshikawa T. Hepatitis C virus and atherosclerosis in patients with type 2 diabetes. JAMA. 2003;289(10):1245–6.

    Article  PubMed  Google Scholar 

  32. Ishizaka N, Ishizaka Y, Takahashi E, et al. Association between hepatitis C virus seropositivity, carotid-artery plaque, and intima-media thickening. Lancet. 2002;359(9301):133–5.

    Article  PubMed  Google Scholar 

  33. Vassalle C, Masini S, Bianchi F, Zucchelli GC. Evidence for association between hepatitis C virus seropositivity and coronary artery disease. Heart. 2004;90(5):565–6.

    Article  PubMed  CAS  Google Scholar 

  34. Liang TJ, Rehermann B, Seeff LB, Hoofnagle JH. Pathogenesis, natural history, treatment, and prevention of hepatitis C. Ann Intern Med. 2000;132(4):296–305.

    PubMed  CAS  Google Scholar 

  35. Ross JS, Keyhani S, Keenan PS, et al. Use of recommended ambulatory care services: is the Veterans Affairs quality gap narrowing? Arch Intern Med. 2008;168(9):950–8.

    Article  PubMed  Google Scholar 

  36. Asch SM, McGlynn EA, Hogan MM, et al. Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample. Arch Intern Med. 2004;141(12):938–45.

    Google Scholar 

Download references

Acknowledgements

None.

Funding

NIH, NIAAA, NHLBI: 2U10 AA 13566, K23 AA015914, and 1R01HL095136-01.

Conflict of Interest

None disclosed.

Primary funding

NIH, NIAAA 2U10 AA 13566 and K23 AA015914

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Matthew S. Freiberg MD, MSc.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Freiberg, M.S., Leaf, D.A., Goulet, J.L. et al. The Association Between the Receipt of Lipid Lowering Therapy and HIV Status Among Veterans Who Met NCEP/ATP III Criteria for the Receipt of Lipid Lowering Medication. J GEN INTERN MED 24, 334–340 (2009). https://doi.org/10.1007/s11606-008-0891-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0891-7

KEY WORDS

Navigation