RESUMEN
The prevalence and control of hypertension (HTN) among people with HIV (PWH) have not been widely studied since the release of newer 2017 ACC/AHA guidelines ("new guidelines"). To address this research gap, we evaluated and compared the prevalence and control of HTN using both 2003 JNC 7 ("old guidelines") and new guidelines. We identified 3,206 PWH with HTN from the DC Cohort study in Washington, DC, between January 2018 and June 2019. We defined HTN using International Classification of Diseases (ICD)-9/-10 diagnosis codes for HTN or ≥2 blood pressure (BP) measurements obtained at least 1 month apart (>139/89 mm Hg per old or >129/79 mm Hg per new guidelines). We defined HTN control based on recent BP (≤129/≤79 mm Hg per new guidelines). We identified socio-demographics, cardiovascular risk factors, and co-morbidities associated with HTN control using multivariable logistic regression [adjusted odds ratio (aOR); 95% confidence interval (CI)]. The prevalence of HTN was 50.9% per old versus 62.2% per new guidelines. Of the 3,206 PWH with HTN, 887 (27.7%) had a recent BP ≤129/≤79 mm Hg, 1,196 (37.3%) had a BP 130-139/80-89 mm Hg, and 1,123 (35.0%) had a BP ≥140/≥90 mm Hg. After adjusting for socio-demographics, cardiovascular risk factors, and co-morbidities, factors associated with HTN control included age 60-69 (vs. <40) years (aOR: 1.42; 95% CI: 1.03-1.98), Hispanic (vs. non-Hispanic Black) race/ethnicity (aOR 1.49; 95% CI: 1.04-2.15), receipt of HIV care at a hospital-based (vs. community-based) clinic (aOR 1.21; 95% CI: 1.00-1.47), being unemployed (aOR 1.42; 95% CI: 1.11-1.83), and diabetes (aOR 1.35; 95% CI: 1.13-1.63). In a large urban cohort of PWH, nearly two-thirds had HTN and less than one-third of those met new guideline criteria. Our data suggest that more aggressive HTN control is warranted among PWH, with additional attention to younger patients and non-Hispanic Black patients.
Asunto(s)
Infecciones por VIH , Hipertensión , Humanos , Persona de Mediana Edad , Anciano , Prevalencia , Estudios de Cohortes , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Hipertensión/epidemiología , Hipertensión/complicaciones , ComorbilidadAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Aspergilosis/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Antifúngicos/efectos adversos , Antifúngicos/uso terapéutico , Terapia Antirretroviral Altamente Activa , Aspergilosis/tratamiento farmacológico , Aspergilosis/epidemiología , Recuento de Linfocito CD4 , Interacciones Farmacológicas , Humanos , Incidencia , Neutropenia/complicaciones , Factores de Riesgo , Estados Unidos/epidemiologíaAsunto(s)
Infecciones por VIH/complicaciones , Hepatitis B Crónica/complicaciones , Complicaciones Infecciosas del Embarazo , Terapia Antirretroviral Altamente Activa , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Guías de Práctica Clínica como Asunto , EmbarazoAsunto(s)
Carcinoma Hepatocelular/complicaciones , Infecciones por VIH/complicaciones , Neoplasias Hepáticas/complicaciones , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Humanos , Factores de Riesgo , Estados UnidosAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Neurosífilis/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Fármacos Anti-VIH/uso terapéutico , Recuento de Linfocito CD4 , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Punción EspinalAsunto(s)
Consumo de Bebidas Alcohólicas/psicología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Cooperación del Paciente , Adolescente , Femenino , Florida , Humanos , Masculino , Factores de Riesgo , Sexo Seguro , Conducta Sexual , Parejas Sexuales , Adulto JovenRESUMEN
Health information technology (HIT) offers the potential to improve care for persons living with HIV. Provider satisfaction with HIT is essential to realize benefits, yet its evaluation presents challenges. An HIV-specific, electronic clinical management and reporting system was implemented in Louisiana's eight HIV clinics, serving over 7500. A serial cross-sectional survey was administered at three points between April 2002 and July 2005; qualitative methods were used to augment quantitative. Multivariable methods were used to characterize provider satisfaction. The majority of the sample (n = 196; T1 = 105; T2 = 46; T3 = 45) was female (80.0%), between ages of 25 and 50 years (68.3%), frequent providers at that clinic (53.7% more than 4 days per week), and had been at the same clinic for a year or more (85.0%). Improvements in satisfaction were observed in patient tracking ( p < 0.05), distribution of educational materials ( p < 0.04), and belief that electronic systems improve care ( p < 0.05). Provider self-reports of time to complete critical functions decreased for all tasks, two significantly so. Time (in minutes) to find current CD4 count decreased at each time point (mean 3.9 [standard deviation {SD} 5.8], 2.9 [2.3], 2.1 [2.6], p>0.05), current viral load decreased at each time point (mean 4.0 [SD 5.6], 2.9 [2.5], 1.8 [2.6], p = 0.08], current antiretroviral status decreased at each time point (mean 3.9 [SD 4.7], 2.9 [3.7], 1.5 [1.1], p < 0.04), history of antiretroviral use decreased at each time point (mean 15.1 [SD 21.9], 6.0 [5.4], 5.4 [7.2], p < 0.04]. Time savings were realized, averaging 16.1 minutes per visit ( p < 0.04). Providers were satisfied with HIT in multiple domains, and significant time savings were realized.
Asunto(s)
Actitud del Personal de Salud , Infecciones por VIH/terapia , Sistemas de Información/estadística & datos numéricos , Sistemas de Registros Médicos Computarizados/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Adulto , Atención Ambulatoria , Fármacos Anti-VIH/uso terapéutico , Estudios Transversales , Femenino , Infecciones por VIH/tratamiento farmacológico , Personal de Salud/psicología , Humanos , Louisiana , Masculino , Persona de Mediana Edad , Tecnología/instrumentaciónAsunto(s)
Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Fármacos Anti-VIH/economía , Recuento de Linfocito CD4 , Esquema de Medicación , Infecciones por VIH/inmunología , Infecciones por VIH/virología , VIH-1 , Humanos , Inhibidores de la Transcriptasa Inversa/efectos adversos , Inhibidores de la Transcriptasa Inversa/economía , Carga ViralRESUMEN
Deaths from liver disease have increased in persons infected with human immunodeficiency virus (HIV) because of coinfection with chronic hepatitis B and C; consequently, all HIV-infected patients should be screened for hepatitis B and C, and all those susceptible should be vaccinated for hepatitis B. Hepatitis A vaccination is indicated for susceptible coinfected patients. It is also important to stress other means of preventing the transmission of hepatitis, such as safe sex and avoidance of blood exposures. Three oral agents, lamivudine, adefovir, and tenofovir, are active against hepatitis B infection. The need for highly active antiretroviral therapy and hepatitis B therapy should be addressed in a coordinated fashion, since two of these agents are active against both HIV and hepatitis B virus. Oral combination therapy for hepatitis B infection looks promising but needs further study. Combination therapy for chronic hepatitis C with pegylated interferon plus ribavirin is the most effective available therapy and the current standard of care. Prior to therapy, patients should be evaluated for contraindications to therapy. During treatment, they should be closely monitored for adverse events.