Patient characteristics and costs associated with dyslipidaemia and related conditions in HIV-infected patients: a retrospective cohort study.
BACKGROUND
Metabolic abnormalities are common in HIV-infected individuals and, although multifactorial in origin, have been strongly associated with antiretroviral therapy.


METHODS
Using automated claims and clinical databases, combined with medical record data, we evaluated the burden of dyslipidaemia (DYS) and associated metabolic abnormalities among a cohort of 900 HIV-infected patients aged 18 years and older who received their care from a large multispecialty medical group between 1 January 1996 and 30 June 2002. A Cox proportional hazards model for DYS was developed. Resource use was compiled and subsequently costed with stratification to account for variable length of follow-up.


RESULTS
Mean follow-up time was 3.3 years. DYS was present in 54% of the cohort and 3.4% experienced a cardiovascular (CV) event. Both unadjusted and adjusted results found patients with dyslipidaemia and cardiovascular events significantly more likely to have received protease inhibitor (PI) treatment for longer periods of time. In the Cox proportional hazards model the following factors were significantly associated with an increased risk for DYS: older age, white race, PI use and male sex. Diagnoses of hypertension, hepatitis C virus infection, depression or opportunistic infections were all negatively associated with a DYS diagnosis. When controlled for length of follow up, patients with DYS (and no CV-related events) incurred greater median and mean total average costs than patients without DYS or CV-related events. For patients with more than 2 years of follow up, these total cost differences were statistically significant (P<0.05).


CONCLUSIONS
These findings indicate that DYS is common among patients with HIV infection and is associated with increased use of medical resources.
Richter
A
A
Defences Resources Management Institute, Naval Postgraduate School, Monterey, CA 93943, USA. arichter@nps.edu
Pladevall
M
M
Manjunath
R
R
Lafata
J E
JE
Xi
H
H
Simpkins
J
J
Brar
I
I
Markowitz
N
N
Iloeje
U H
UH
Irish
W
W
D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D000998:Antiviral Agents / Q000191:economics / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000191:economics / Q000821:virology*; D016208:Databases, Factual; D016527:Drug Costs; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000191:economics; D017320:HIV Protease Inhibitors / Q000191:economics / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D006949:Hyperlipidemias / Q000191:economics / Q000209:etiology*; D000960:Hypolipidemic Agents / Q000191:economics / Q000627:therapeutic use*; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D044465:White People
D000998:Antiviral Agents; D017320:HIV Protease Inhibitors; D000960:Hypolipidemic Agents