November 18, 2016
This week, a study finds that people living with HIV who also have kidney disease have a higher risk of cardiovascular disease as well. Another study finds that taking statins may help prevent cirrhosis in individuals living with HIV and hepatitis C. And when it comes to achieving an undetectable viral load, a study reports that racial disparities still exist. To beat HIV, you have to follow the science!
People living with HIV who suffer from renal impairment are more likely to experience cardiovascular disease events (CVD), and to do so more quickly, than those living with HIV and normal renal function, according to an analysis of data from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study that was published in The Journal of Infectious Diseases.
Researchers compared estimated glomerular filtration rates (eGFR) in study participants who had a clinical CVD event. About 60 percent of those with a CVD had an eGFR of 90 mL/minute/1.73 m2 or lower before the cardiovascular problem. Normal eGFR is above 90 mL/min/1.73 m2, although it declines with age.
The most common CVD in the study was myocardial infarction, followed by angioplasty and stroke. Study authors called for more intense monitoring of emerging CVD in those with low eGFR levels and "an increased focus on applying different renal and cardiovascular preventive measures in HIV-positive individuals."
Taking statins protects against cirrhosis of the liver among people living with HIV and hepatitis C (HCV), an analysis of data from the Department of Veterans Affairs' Clinical Case Registries published in AIDS found.
Almost 6,000 men living with HIV and HCV were included in the analysis. The majority were African American, with a mean age of 45 years. More than half of study participants had hypertension, 16% had diabetes and more than 20% were obese.
The benefit of statins was significant among those with an alanine aminotransferase (ALT) level of 40 IU/l or less -- that is, whose ALT levels were still in the normal range. In that group, every 30% increase in the time during which someone took statins lowered his risk of developing cirrhosis by 32%. Among those with elevated ALT levels, each 1% increase in time on statins was associated with a non-significantly lower risk of cirrhosis. These results show that statins "should be considered in patients even with chronic liver disease," study authors concluded.
While racial and ethnic disparities in prescription rates of antiretroviral therapy declined significantly by 2013, rates of viral suppression continue to be lower among African Americans, an analysis of medical data between 2009 and 2014 published in Journal of Acquired Immune Deficiency Syndromes found.
The data came from the Medical Monitoring Project, which surveys people living with HIV who receive medical care in the U.S. Study authors explain the difference in antiretroviral prescription rates between African Americans and whites in part by the fact that a higher proportion of African Americans were more recently diagnosed with HIV and therefore may not yet have started treatment.
They call for "evidence-based programs that address the social determinants of health," as well as better cultural competency among providers, to help narrow the racial gap in viral suppression rates. Among men who have sex with men, that gap has closed between Latinos and whites, but persists between African Americans and whites.
Warren Tong is the senior science editor for TheBody.com and TheBodyPRO.com. Follow Warren on Twitter: @WarrenAtTheBody.
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