| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 106 === BACKGROUND:
People living with HIV/AIDS (PLWHA) will increase the risk of cardiovascular disease due to HIV virus and the side effects of HAART drugs. The guidelines recommend that PLWHA need to check biochemistry regularly. However, there are few studies about impact of HIV infected, HAART, and regular to check biochemistry on cardiovascular disease in Taiwan.
PURPOSE:
The aim of this study was to investigate the effect of HIV infected (fist aim), HAART therapies include HAART use, HAART PDC (Calculating Proportion of Days Covered), HAART class, HAART ingredients (second aim), and regular to check biochemistry include CHD, TG, GLU, GOT, GPT, CREA (third aim) on the risk of cardiovascular disease.
METHODS: A population-based database was used in this national retrospective cohort study, Each HIV-infected was matched on gender, year of birth, and index date to 4 uninfected subjects. All subjects enrolled on or after January 1, 2001, and followed up through December 31, 2015 or death. The independent variables were cardiovascular disease. Use Poisson regression and Cox regression were used to analyze correlations between HIV, HAART, check biochemistry regularly and cardiovascular disease.
RESULTS:
The overall incidence density of cardiovascular disease hospitalization was 5.51/1,000 person-years in HIV and 2.94/1,000 person-years in reference (AHR=1.86 [1.66-2.09], p<0.001). The relative risk of cardiovascular disease hospitalization associated with HIV infection was higher among women and younger age groups. PLWHA receiving HAART (AHR=1.28 [1.01-1.62], P<0.05) had higher risk of cardiovascular disease hospitalization compared to those who were untreated. However, if the group is based on the HAART PDC, PDC≧80% had lower risk of cardiovascular disease hospitalization. PLWHA using protease inhibitor (PI) had higher risk of cardiovascular disease hospitalization but not significance. PLWHA using TENOFOVIR (AHR=1.53 [1.24-1.90], P<0.001), LOPNAVIR (AHR=1.73 [1.09-2.75], P<0.05) had higher risk of cardiovascular disease hospitalization, but using ENTRICITABIME (AHR=0.72 [0.54-0.95], P<0.05) had lower risk of cardiovascular disease hospitalization. PLWHA receiving HAART therapies was check biochemistry regularly had lower risk of cardiovascular disease hospitalization.
CONCLUSIONS:
People who infect HIV will increase the risk of hospitalization for cardiovascular disease. Receiving HAART treatment will increase the risk of hospitalization for cardiovascular disease, but when HAART PDC≧80% or compliant with guidelines to check biochemistry regularly will decrease the risk of hospitalization for cardiovascular disease. It is suggested that the policy makers should strengthen the importance of compliance with the guidelines. Pay-for-Performance (P4P) should be designed to provide appropriate incentives for medical providers who given appropriate examinations to PLWHA for compliance with guidelines. Otherwise, it is importance to let public know that when infected HIV will increase the risk of cardiovascular disease. It is important that health care providers should enhance PLWHA to have good HAART adherence and check regularly, it will not only can decrease HIV viral load, but also reduce the risk of cardiovascular disease.
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