High burden of metabolic comorbidities in a citywide cohort of HIV outpatients: evolving health care needs of people aging with HIV in Washington, DC
Objectives With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide...
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Published in | HIV medicine Vol. 18; no. 10; pp. 724 - 735 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
England
Wiley Subscription Services, Inc
01.11.2017
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Subjects | |
Online Access | Get full text |
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Summary: | Objectives
With the increasing impact of cardiovascular disease among populations aging with HIV, contemporary prevalence estimates for predisposing metabolic comorbidities will be important for guiding the provision of relevant lifestyle and pharmacological interventions. We estimated the citywide prevalence of hypertension, type 2 diabetes, dyslipidaemia, and obesity; examined differences by demographic subgroups; and assessed clinical correlates.
Methods
Utilizing an electronic medical record (EMR) database from the DC Cohort study – a multicentre prospective cohort study of HIV‐infected outpatients – we assessed the period prevalence of metabolic comorbidities between 2011 and 2015 using composite definitions that incorporated diagnoses, pharmacy records, and clinical/laboratory results.
Results
Of 7018 adult patients (median age 50 years; 77% black), 50% [95% confidence interval (CI) 49–51] had hypertension, 13% (95% CI: 12–14) had diabetes, 48% (95% CI: 47–49) had dyslipidaemia, and 35% (95% CI: 34–36) had obesity. Hypertension was more prevalent among black patients, diabetes and obesity were more prevalent among female and black patients, dyslipidaemia was more prevalent among male and white patients, and comorbidities were more prevalent among older patients (all P < 0.001). For many patients, evidence of treatment for these comorbidities was not available in the EMR. Longer time since HIV diagnosis, greater duration of antiretroviral treatment, and having controlled immunovirological parameters were associated with metabolic comorbidities.
Conclusions
These findings underscore the pervasive burden of metabolic comorbidities among HIV‐infected persons, serve as the basis for future analyses characterizing their impact on subsequent adverse cardiovascular outcomes, and highlight the need for an increased focus on the prevention and control of comorbid complications in this population. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Undefined-2 DC Cohort Executive Committee: Debra Benator, MD, Veterans Affairs Medical Center; Princy Kumar, MD, Georgetown University; Deborah Goldstein, MD and David Hardy, MD, Whitman-Walker Health; David Parenti, MD, George Washington Medical Faculty Associates; Maria Elena Ruiz, MD, Washington Hospital Center; Angela Wood, MSW, Family and Medical Counseling Service; Lawrence D’Angelo, MD, MPH, Burgess Adolescent Clinic, Children’s National Medical Center; Natella Rakhmanina, MD, PhD, Special Immunology Service Pediatric Clinic, Children’s National Medical Center; Sohail Rana, MD, Pediatric Clinic, Howard University Hospital; Saumil Doshi, MD, Adult Infectious Disease Clinic, Howard University Hospital; Annick Hebou, MD, MetroHealth; Ricardo Fernandez, MD, La Clinica Del Pueblo; Stephen Abbott, MD, Unity Health Care; Michael Kharfen, BA, HIV/AIDS, Hepatitis, Sexually Transmitted Diseases, Tuberculosis Administration (HAHSTA), DC Department of Health; and Henry Masur, MD, National Institutes of Health. |
ISSN: | 1464-2662 1468-1293 |
DOI: | 10.1111/hiv.12516 |