Page 26 - Delaware Medical Journal - March/April 2020

TABLE 3. Comparison of cardiovascular risk factor-modification strategies between HIV-positive women and men
HIV-positive women (N=24)
HIV-positive men (N=62)
P value
Physician’s advice on lifestyle modification
Told to lose weight, n (%)
4 (16.7)
6 (9.7)
0.36
Told to exercise, n (%)
7 (29.2)
12 (19.4)
0.33
Told to modify diet, n (%)
8 (33.3)
14 (22.6)
0.31
Patient’s adherence to lifestyle modification
Trying to lose weight, n (%)
7 (29.2)
14 (22.6)
0.52
Trying to increase exercise, n (%)
6 (25.0)
23 (37.1)
0.29
Taking the prescribed medicines, n (%)
6 (25.0)
8 (12.9)
0.17
Trying to modify diet, n (%)
9 (37.5)
24 (38.7)
0.92
HIV=Human Immunodeficiency Virus
health care provider’s advice to reduce the risk was also compared. SPSS v.21 was used for analysis and a p-value less than 0.05 was considered significant.
RESULTS
The total number of participants in the NHANES datasets was 82,091. Participants with a history of stroke, cardiovascular disease (CVD), angina, and cerebrovascular accident were excluded as the focus is on primary prevention of CAD. Participants less than 18 years old and those with missing data were further excluded.
Out of the available sample, 86 people were positive for HIV. There were 24 women (27.9%) and 62 men (72.1%)
in this sample. The majority of the HIV-positive women were African American (83.3%), unmarried (50%), non-smokers (100%), or non-diabetics (87.5%) with no history of hypertension (75%) or family history of CVD (87.5%). The mean Framingham risk score of HIV-negative women (M=1.21, SD=2.47) was significantly lower
than the HIV-negative men (M=3.47,
SD=4.00), p<0.001. However, in HIV- positive women, the mean Framingham score increases to 2.55 (M=2.55, SD=3.20). There was no statistically significant difference as compared
to the HIV-positive men (M=3.66, SD=4.36), p=0.55 (Table 2). There was neither any significant difference in the risk-factor modification pattern nor in the pattern of advice from their health care providers between the two groups (Table 3).
DISCUSSION
These results confirm that the risk of developing CAD in our HIV-positive women is higher from the traditional risk factors themselves, irrespective of the additional risk they might acquire from the HIV infection.
Like many other gender-specific guidelines and recommendations that have been laid out lately, the current prevention guidelines in practice may not be applicable for the HIV-positive women.3 They need aggressive control of the risk factors as compared to HIV- positive men. Without this approach,
CAD risk-stratification strategies for HIV-positive women will remain sub- optimal.
Treatment of HIV infection has become easily accessible and effective in many clinical settings across the globe. This has led to a significant decrease in the mortality and morbidity related to HIV and AIDS-related complications of advanced HIV disease.7 Though HIV- related mortality has been decreasing, there has been a steady increase in the proportion of deaths attributable to noninfectious complications of HIV, including cardiovascular diseases.8,9
It is a known fact that HIV-infected women have higher rates of developing CAD as compared to uninfected women.10 Studies have shown that the increased risk was persistent even after adjustment for demographic factors, other comorbidities, and alcohol or cocaine abuse.8,9
Our results show that over a period
of 16 years of the study, the risk of developing cardiovascular disease is high from the traditional risk factors themselves in the HIV-positive women as compared to the HIV-positive men.
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Del Med J | March/April 2020 | Vol. 92 | No. 2