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Increasing Hypertension and Diabetes Rx for
HIV+ Women, But Poor Control
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Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston
Mark Mascolini
Treatment of hypertension and diabetes rose over time in an 8-year analysis of the Women's Interagency HIV Study (WIHS) [1]. But more than 40% of HIV-positive women did not reach hypertension-control targets and 25% did not hit diabetes targets [1]. Still, HIV-positive women controlled both hypertension and diabetes better than HIV-negative women in the WIHS cohort.
WIHS investigators set out to assess trends in managing three major nonlipid cardiovascular risk factors in women enrolled in WIHS at some point from 2006 into 2014: hypertension, diabetes, and smoking. WIHS is a longitudinal six-site observational cohort of women with or at risk for HIV infection. Women aim to make study visits every 6 months.
This analysis focused on three subgroups between April 1, 2006 and March 31, 2014. The researchers defined hypertension as having at least one study visit with systolic blood pressure at or above 140 mm Hg, diastolic blood pressure at or above 90 mm Hg, self-reported hypertension, or a history of taking antihypertensives. The researched classified women as diabetic if they had at least one study visit with fasting glucose at or above 126 mg/dL or hemoglobin (Hg)A1c at or above 6.5%, self-reported diabetes, or a history of taking antidiabetics. Recent smokers were women who made at least one study visit in which they reported smoking at the previous visit. Hypertension control meant reaching a blood pressure below 140/90 mm Hg through treatment; diabetes control meant reaching a fasting glucose below 130 mg/dL or HgA1c below 7% through treatment, and smoking control meant quitting.
The hypertension subgroup included 1039 women with HIV and 405 without HIV (median ages 51 and 50); the diabetes group had 332 women with HIV and 142 without HIV (median ages 50 and 49); recent smokers numbered 806 with HIV and 400 without HIV (median ages 48 and 46). About two thirds of all women were black and most of the rest Hispanic.
In the hypertension analysis, 40% of women with HIV and 38% without HIV had hypertension. In the diabetes analysis, 21% with HIV and 22% without HIV had diabetes. In the smoking analysis, 37% of women with HIV and 48% without were recent smokers.
Among women with hypertension, the proportion treated rose from 72% to 81% from 2006 to 2014 in women with HIV and from 63% to 73% in women without HIV (P < 0.001). Despite rising treatment rates, proportions of women achieving control over the study period rose only from 55% to 59% in women with HIV and from 45% to 46% in women without HIV. The gain in hypertension control in women with HIV reached statistical significance (P = 0.01).
Among women with diabetes, those with and without HIV made significant gains in proportions receiving treatment from 2006 to 2014 (37% to 63% with HIV, 34% to 64% without HIV, P < 0.001 for both gains). But the proportion of HIV-positive women achieving diabetes control dropped among women with HIV, from 74% to 68% when measured as fasting glucose, while the proportion of HIV-negative women achieving control inched up from 65% to 67%.
In the smoking analysis, 9% of women with HIV stopped smoking in 2006, as did 9% in 2013. Results were nearly identical among HIV-negative women.
The WIHS investigators concluded that use of antihypertensive and antidiabetic medications rose in both HIV-positive and negative women over the 8-year study period. But those gains "coincided with only small or no improvements in [hypertension and diabetes] control." The researchers stressed that more than 40% of HIV-positive women had poorly controlled blood pressure at the end of the study period. Diabetes control was more frequent than hypertension control in HIV-positive women but actually waned over the study period when measured as fasting glucose.
The WIHS team reminded colleague clinicians that they "are uniquely positioned to teach their patients about preventive strategies (including lifestyle interventions) to reduce cardiovascular disease risk."
Reference
1. Hanna DB, Jung J, Anastos K, et al. 9-Year trends in non-lipid cardiovascular disease prevention strategies in HIV+ women. Conference on Retroviruses and Opportunistic Infections (CROI), February 22-25, 2016, Boston. Abstract 647.
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