CVD is a Leading Cause for Hospital Admission Among HIV/AIDS Patients

Study Demonstrates Cardiovascular Disease is a Leading Cause for
Hospital Admission Among HIV/AIDS Patients

- Study Presented at 9th European AIDS Conference (EACS) in Warsaw -

WARSAW, Poland, Oct. 29 /PRNewswire/ -- Results from a recent study
showed that cardiovascular disease is a leading cause for hospital
admissions among HIV/AIDS patients(1). In an analysis of a large managed
care database, researchers found that, compared to other known
complications of antiretroviral therapy, cardiovascular disease is a
more common reason for hospital admission among HIV patients. The
results were presented this week at the 9th European AIDS Conference
(EACS).

. . .

This study evaluated the relative impact of key morbidities in the HIV
population using data analyzed from several managed health care plans in
the 2000 and 2001 calendar years. The authors determined cardiovascular
disease to be a leading cause of morbidity among patients in this study
(8.5%) -- more prevalent than conditions related to renal disease
(5.8%), hepatotoxicity (5.6%) or opportunistic infections (3.4%).

. . .

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http://www.hivandhepatitis.com/2003icr/EACS_9/main.html

Selected Hospital Admission Rates for Patients Who Received HAART

C. Fichtenbaum1, D. Lee2, W. Broderick2, M. Emons2, G. Goldberg2,
M. Haberman2, R. Vendiola2

1University of Cincinnati, Cincinnati, Ohio, USA,
2Constella Health Strategies, Santa Monica, CA, USA

Objective

To evaluate the relative impact of key morbidities in the HIV
population, we analyzed data from several managed health care
plans. Admission rates and discharge diagnoses were assessed
to determine the relative frequency of adverse events for
patients who were prescribed HAART.

Methods

The study examined 2000 and 2001 calendar year data
contained within a large, managed care database. The
managed care database contains private health care claims and
enrollment data representing health care services provided
through HMO, PPO, and specialty products to approximately
three million medical members. Patient entry criteria included:

• Patient filled prescription drug claims for > 3 unique
antiretroviral agents between Jan. 1, 2000 and June 30, 2000

• Patient > 18 years of age and < 90 years of age as of Dec.
31, 2000

• Patient was not covered by Medicare Supplemental Insurance

• Patient was eligible for medical benefits and pharmacy
benefits throughout the study period

Hospital admission rates for conditions associated with HAART
side effects and/or HIV infection were calculated for the Study
Group. Discharge diagnoses and ICD-9-CM procedure
information from each inpatient hospitalization claim were used
to determine reasons for admission. Each admission was
categorized into one or more of eight categories:

- Hepatitis/abdominal pain
- Non-opportunistic infections
- Opportunistic infections
- Atherosclerotic cardiac and vascular disease
- Kidney disease
- Anemia/neutropenia/thrombocytopenia
- Psychosis
- Other

Patients in the study could have more than one
diagnosis/procedure per admission.

Patients who had admissions related to atherosclerotic cardiac
and vascular disease were assigned to one or more comorbid
condition categories. These categories were formed by
grouping clinically similar ICD-9-CM diagnosis codes into one of
186 diagnostic groupings. The assignment was based on all
facility and professional claims submitted during the study
period.

Results

The demographic characteristics of the Study Group receiving
HAART are depicted in Table 1 and Figure 1.

• Median age was 45 years

• 81.5% were male

• 71% had exposure to protease inhibitors (PIs)

Demographics for the hospitalized group are depicted in Table 2
and Figure 2.

• The hospitalized group represented 23% of the Study Group
(29% of females and 22% of males)

• Median age for hospitalized patients was 46 years

• 77% of hospitalized patients were male

There were 340 hospital admissions during the study period.
The admission rate for all selected reasons was 44.97 per 100.
The top reasons for admission are illustrated in Figure 3.

• Admissions for atherosclerotic cardiac and vascular disease
were the most commonly observed reason for admission after
non-opportunistic infections

• The admission rate for atherosclerotic cardiac and vascular
disease was approximately 50% higher than the admission
rate for hepatitis/abdominal pain (p<0.05).

- The mean age of patients admitted for atherosclerotic
cardiac and vascular disease was 55.6 years, and 80%
were male.

- Among the patients admitted for atherosclerotic cardiac
and vascular disease, 42.5% had a comorbid diagnosis of
hypertension and 22.5% diabetes.

• The admission rate for opportunistic infections was ranked
last among the conditions studied.

Discussion

Through the introduction of new, effective drug treatments, the
prognosis for patients with HIV/AIDS has improved dramatically
over the past decade. HIV therapy has evolved from the
treatment of life-threatening complications to the management of
a chronic disease. Opportunistic infections are no longer a
primary adverse event leading to hospital admission. Comorbid
conditions and adverse drug events are now significant factors
determining clinical outcomes for patients receiving HAART.

Clinicians managing HIV patients should pay
increased attention to risk factors for cardiac,
renal or hepatic disease.

• Cardiovascular-related adverse events were the leading
cause of morbidity among conditions associated with known
complications of antiretroviral therapy.

• The association of HAART with dyslipidemia and
hyperglycemia is well established.1,2

- The increased risk of cardiovascular disease associated
with exposure to HAART, primarily PIs, is likely mediated
by the effects HAART has on the metabolism of lipids and
glucose.3,4

• In this study, the relatively high prevalence of hypertension
and diabetes among those hospitalized with cardiovascular
conditions is consistent with other reports that known cardiac
risk factors contribute to the risk of cardiovascular comorbidity
in the HIV population.5,6

• Evidence continues to accumulate suggesting that HIV
patients on HAART may have a higher incidence of acute
coronary events.7,8

• Patients at greatest risk of hepatoxicity are those with
comorbid chronic hepatitis, which can be diagnosed with liver
function tests and serology.

Conclusion

Results from the present study demonstrate that HIV patients
are more often hospitalized due to atherosclerotic cardiovascular
disease than for conditions related to renal disease,
hepatotoxicity or opportunistic infections. These results suggest
that risk factors for cardiovascular disease should be an
important consideration for physicians prescribing HAART
regimens, particularly in treating patients over the age of 40.
Therapeutic considerations should include smoking cessation,
the management of lipids and hyperglycemia, and the careful
selection of antiretroviral agents.

References

1 Behrens G, Dejam A, Schmidt H et al. Impaired glucose
tolerance, beta cell function and lipid metabolism in HIV
patients under treatment with protease inhibitors. AIDS
1999,13:F63-F70

2 Periard D, Telenti A, Sudre P et al. Atherogenic dyslipidemia
in HIV-infected individuals treated with protease inhibitors.
Circulation 1999;100:700-705

3 Tsiodras S, Mantzoros C, Hanner S et al. Effects of protease
inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy.
Arch Intern Med 2000; 160(13):2050-56

4 Koppel K, Bratt G, Eriksson M et al. Serum lipid levels
associated with increased risk for cardiovascular disease is
associated with highly active antiretroviral therapy (HAART) in
HIV-1 infection. Int J STD AIDS 2000;11:451-55

5 David MH, Hornung R, Fichtenbaum CJ. Ischemic
cardiovascular disease in persons with Human
Immunodeficiency Virus infection. CID 2002;34:98-102

6 Moore RD, Keruly JC, Lucas G. Increasing incidence of
cardiovascular disease in HIV-infected persons in care. 10th
Conference on Retroviruses and Opportunistic Infections,
2/2003, Boston MA

7 Holmberg SD, Moorman AC, Williamson JM et al. Protease
inhibitors and cardiovascular outcomes in patients with
HIV-1. Lancet 2002;360: 1747-48

8 Klein D, Hurley L. Hospitalizations for coronary heart disease
and myocardial infarction among men with HIV-1 infection:
Additional follow-up. Poster Session 92 (747). 10th
Conference on Retroviruses and Opportunistic Infections,
2/2003, Boston MA