Bullock Museum

Objective: Chronic HIV infection itself confers cardiovascular (CV) risk, but CV risk reduction is often not a focus in the primary care of people living with HIV (HIV+). We examined the prevalence and predictors of poor control of CV risk factors (RF) in a predominantly Hispanic HIV+ cohort. Methods: From the South Texas HIV Cohort, a registry of HIV+ patients in a public primary care clinic and serving the entire region, we used electronic medical record (EMR) data to assess control of 5 CV RFs in a cross-sectional study. We selected HIV+ adults with ≥2 HIV clinic visits in 2013 and identified: active smokers, uncontrolled hypertension (HTN), elevated cholesterol, obesity, and uncontrolled diabetes mellitus (DM). Active smokers were documented as having ongoing use in 2013. Persons with uncontrolled HTN had ≥2 blood pressures >140/90 mmHg. A total cholesterol >200mg/dl was categorized as poorly controlled. Persons with obesity had median BMI ≥30kg/m 2 in 2013. Among persons with DM based on ≥2 ICD-9-CM diagnosis codes or a hemoglobin A1c ≥6.5%, uncontrolled DM was defined as any A1c ≥8%. Virologic suppression was defined as all HIV-1 plasma RNA measurements <200 copies/ml in 2013. Logistic regressions were used to predict the odds of ≥1 RF and of each RF separately adjusting for years living with HIV, age, race, gender, insurance, HIV risk factor, HCV infection, substance abuse and virologic suppression. Results: Of 1696 patients meeting inclusion criteria, the median age was 44.8 yr (IQR: 34.5, 51.5), 76.3% were men, 61.6% Hispanic, and 17.7% African American. The most common HIV RF was men who have sex with men (MSM, 56.4%); 82.6% of the cohort was receiving antiretroviral therapy and 60.5% were virologically suppressed. DM was found in 14.4% of the cohort. At least 1 CV RF was present for 69.5% (1180 of 1698). The proportions with each RF were: 32.0% active smoking, 25.6% uncontrolled HTN, 15.4% uncontrolled cholesterol, and 27.7% obese; 28.3% DM were uncontrolled (69 of 244). Multiple CV RFs (≥2) were present for 27.8% of the cohort. Medicaid insurers were 80% more likely to have multiple CV RFs than Medicare insurers (AOR=1.80, 95% CI: 1.12, 2.91); and patients with heterosexual transmission were 47% more likely to have multiple CV RFs than those with MSM (AOR=1.47, 95% CI: 1.06, 2.05). Women were more than twice as likely to be obese than men (AOR=2.55; 95% CI: 1.80, 3.63). Conclusions: In this majority Hispanic HIV+ cohort, 70% of patients had at ≥1 uncontrolled CV risk factor and 28% had two. Persons with Medicaid insurance and heterosexual transmission were significantly more likely to have an uncontrolled CV risk factor, and women were more than twice as likely to be obese. Without population-appropriate CV risk reduction interventions, the life expectancy gains achieved with highly active antiretroviral therapy in this vulnerable population are jeopardized by the threat of CV morbidity and mortality.