Lipid screening in HIV-infected veterans.
BACKGROUND
Lipid screening is recommended for patients taking protease inhibitors (PIs).


METHODS
We examined data from the Veterans Administration Immunology Case Registry to assess lipid screening among HIV-infected veterans who received PIs for at least 6 consecutive months during 1999 and 2001. We estimated crude and adjusted associations between lipid screening and patient characteristics (age, gender, HIV exposure, and race/ethnicity), comorbidities (AIDS, cardiovascular disease, diabetes, hypertension, smoking, and hyperlipidemia), and facility characteristics (urban location, case management, guidelines, and quality improvement programs).


RESULTS
Among 4065 patients on PIs, clinicians screened 2395 (59%) for lipids within 6 months of initiating treatment. Adjusting for patient characteristics, comorbidities, facility traits, and clustering, lipid screening was more common among patients who were cared for in urban areas (relative risk [RR] = 1.3, confidence limits: 1.0-1.5), diabetic (RR = 1.2, confidence limits: 1.1-1.3), or previously hyperlipidemic (RR = 1.4, confidence limits: 1.3-1.5) and less common among patients with a history of intravenous drug use (IVDU) (RR = 0.90, confidence limits: 0.79-1.0) or unknown HIV risk (RR = 0.85, confidence limits: 0.75-0.95).


CONCLUSIONS
Six in 10 patients taking PIs receive lipid screening within 6 months of PI use. Systemic interventions to improve overall HIV quality of care should also address lipid screening, particularly among patients with unknown or IVDU HIV risk and those cared for in nonurban areas.
Korthuis
P Todd
PT
Oregon Health and Sciences University, Portland 97239-3098, USA. korthuis@ohsu.edu
Asch
Steven M
SM
Anaya
Henry D
HD
Morgenstern
Hal
H
Goetz
Matthew Bidwell
MB
Yano
Elizabeth M
EM
Rubenstein
Lisa V
LV
Lee
Martin L
ML
Bozzette
Samuel A
SA
D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008055:Lipids / Q000097:blood*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D044469:Racial Groups; D012042:Registries; D012044:Regression Analysis; D012907:Smoking; D014481:United States; D014728:Veterans
D008055:Lipids