Cardiovascular Risk Among HIV-Positive Subjects Preceding Exposure to HAART: A Retrospective Claims Analysis

Abstract

Background: Cardiovascular disease (CVD) causes significant morbidity and mortality in HIV-infected individuals. Advancing age, chronic HIV-associated inflammation and antiretroviral therapy in part contributes to the increased risk of CVD in these patients. Aim: This study aimed to compare the CVD- and HIV-related morbidity of subjects prior to initiating an non-nucleoside reverse transcriptase inhibitor (NNRTI)- versus a protease inhibitor (PI)-based HAART regimen. Methods: Subjects in this retrospective, observational study of medical claims data representing HIV-infected beneficiaries from May 2000 to December 2009 were assigned either to a PI initiator group (n = 2192) or to a NNRTI initiator group (n = 3338). The case mix similarities and differences between the two groups were compared. Results: More subjects in the PI group had previous treatment with nucleoside reverse transcriptase inhibitor therapy or with the fusion inhibitor enfuvirtide, whereas more subjects in the NNRTI group had prior treatment with lamivudine plus zidovudine. Uncontrolled Type 2 diabetes, substance abuse, drug dependence, cardiovascular morbidity, heart failure, nonhypertension kidney dysfunction, depression, AIDS-related diagnosis, Kaposi‘s sarcoma, candidiasis and cachexia were observed more often in the PI group. Subjects in the PI group were more likely to be receiving medications for AIDS conditions. Only smoking cessation medication showed a higher prevalence in the NNRTI group. Conclusion: Subjects initiating PI-based versus NNRTI-based therapy had a greater prevalence of specific comorbidities that may adversely affect CVD risk profile.

Keywords:

• antiretroviral therapy
• cardiovascular disease risk
• HIV

Financial & competing interests disclosure

No external support was received for the study other than that provided by AbbVie Inc./Abbott Laboratories. At the time this study was conducted, all of the authors on this study were employed by Abbott Laboratories, the manufacturer of Kaletra^® and Norvir^®. Abbott employees and former employees may own Abbott/AbbVie stock or options. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

A Styhler of SNELL Medical Communication Inc. provided assistance in the writing and preparation of this manuscript – this support was funded by Abbott. The authors retained full editorial control of the manuscript content.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations. In addition, for investigations involving human subjects, informed consent has been obtained from the participants involved.

Notes

MI: Myocardial infarction.

ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker; HIC3: Three-digit hierarchical classification code; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification.

Additional information

Funding

No external support was received for the study other than that provided by AbbVie Inc./Abbott Laboratories. At the time this study was conducted, all of the authors on this study were employed by Abbott Laboratories, the manufacturer of Kaletra^® and Norvir^®. Abbott employees and former employees may own Abbott/AbbVie stock or options. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. A Styhler of SNELL Medical Communication Inc. provided assistance in the writing and preparation of this manuscript – this support was funded by Abbott. The authors retained full editorial control of the manuscript content.