Session number: 1067
Abstract title: Cardio- and Cerebrovascular Outcomes with Changing Process of Anti-HIV Therapy in Veterans
Author(s):
SA Bozzette - VA San Diego
J Jean - VA San Diego
A Schepps - VA San Diego
C Ake - VA San Diego
C Bowman - VA San Diego
S Chang - VA Ctr for Quality
T Louis - RAND
Objectives: Since shortly after protease inhibitors became available in 12/95, VA and general HIV treatment guidelines have advocated intensive multidrug anti-HIV therapy for patients with indications, and prior work by the QUERI-HIV indicates that most care is consistant with this recommendation. With longer and more aggressive treatment, there has come an increasing prevalence of lipid metabolism abnormalities, accompanied by provider and patient concern regarding associated adverse health effects. This study evaluates the effect of changing processes of care on cardiovascular, cerebrovascular, and mortality outcomes in HIV+ veterans.
Methods: We analyzed 6-8 years of data from the Quality Enhancement Database (QED) of the QUERI-HIV, a dataset formed from the Immunology Case Registry of the VA AIDS Service, other VA databases, and the national death index. Initial analyses tracked the rate of outcome events over time, bracketing the date of release of highly active combination therapy in December of 1995.
Results: Between 1993 and 2000, the VA saw 16,599 to 19,739 unique HIV+ patients per year, providing a total of 1.4 million antiviral prescriptions and ~85,000 patient-years of HIV care. Patients required admissions for cardio- or cerebrovascular disease at rates per 100 patient-years of 1.7 in 93; 1.8 in 94, 95, & 96; 1.4 in 97; 1.7 in 98; 1.5 in 99; and 1.5 in 00. Including deaths attributable to vascular disease yielded similar results. All cause mortality rates were 20.6, 25.3, 26.0, 20.5, 12.0, and 9.9 in 93, 94, 95, 96, 97, and 98, respectively.
Conclusions: Preliminary analyses indicate that the availability and diffusion of aggressive highly active antiretroviral treatment across the VA was not accompanied by increasing rates of cardio- or cerebrovascular events, but was accompanied by sharp declines in mortality.
Impact statement: Results support efforts by the AIDS Service and QUERI-HIV to promote more aggressive antiretroviral therapy for those with indication. The complete analysis of findings from this study will significantly inform efforts by the QUERI-HIV to influence changing prescribing practices while mitigating fear of vascular disease as a reason for not prescribing or taking indicated treatment.