4th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV 22-25 September 2002, San Diego, CA, USA

Antiviral Therapy 2002; 7:L29 (abstract 42)

UH Iloeje¹, KS Yu-Isenberg², EP Ventura², AV Tuomari^3
1Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Wallingford, Conn., USA; ²Pharmacoeconomics and Health Outcomes Research, Prescription Solutions, Costa Mesa, Calif., USA; ³Pharmaceutical Research Institute, Bristol-Myers Squibb Company, Plainsboro, NJ, USA

OBJECTIVE: Long term complications of antiretroviral therapy (ART), such as dyslipidemia, are becoming more prevalent as survival improves among HIV patients. Changes in dyslipidemia treatment over time may reflect enhanced clinician concern over this issue as well as define a future cost driver. Our objective was to describe the prevalence of lipid lowering therapy in HIV patients and evaluate the association with protease inhibitor (PI) use.

METHODS: Adult HIV patients in a large managed care organization database were identified by ICD-9 code or by ART. Lipid lowering agents and ARTs were identified by GPI drug codes. Cochran-Armitage test for trends of lipid lowering therapy use were performed. Odds ratio (OR) for association of lipid therapy with PI use was estimated by Cochran-Mantel-Haenszel test.

RESULTS: Sample size per year (1998-2001) was 3249, 3594, 4023 and 3847, respectively; prevalence of PI use per year was 70%, 68%, 61% and 55%; prevalence of lipid-lowering therapy was 2.2%, 2.4%, 5.5% and 5.5% among treatment-naïve (P<0.0001); 4.6%, 6.1%, 10.1% and 12.2% in non-PI-treated (P<0.0001); 8.7%, 12.6%, 14.3%, and 18.4% in PI-treated group (P<0.0001). Adjusting for year, the OR of association between PI use and lipid therapy was 2.36 (95% CI 2.09-2.68).

CONCLUSIONS: We noted a significant increase in treatment of dyslipidemia in HIV patients, the prevalence being highest in the PI-exposed with almost 1 in 5 receiving treatment in 2001. The use of a PI significantly increased the odds of receiving lipid therapy. This trend is expected to continue with continued use of PIs. The increased prescribing of lipid-lowering agents among PI patients reflects clinician concern over the risk for subsequent artherosclerosis and may place patients at risk for treatment complications. The management of dyslipidemia in this population represents a poorly described future cost driver.

Presenting author: UH Iloeje

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