Assessment of HIV Comorbidities Andrew Carr, MBBS, MD, FRACP, FRCPA HIV, Immunology and Infectious Diseases Unit Clinical Research Program, Centre for Applied Medical Research St. Vincent’s Hospital and University of New South Wales Sydney, Australia
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Assessment of HIV Comorbidities Andrew Carr, MBBS, MD, FRACP, FRCPA HIV, Immunology and Infectious Diseases Unit Clinical Research Program, Centre for.
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Assessment of HIV Comorbidities
Andrew Carr, MBBS, MD, FRACP, FRCPAHIV, Immunology and Infectious Diseases Unit
Clinical Research Program, Centre for Applied Medical Research
St. Vincent’s Hospital and University of New South Wales
Why comorbidities matter• More common cause of morbidity and mortality than AIDS in patients on ART• ART accelerates comorbidities that are common, eg, CVD, CKD, fractures• Increase complexity of care
– reduce ART adherence
– reduce ART options
– increase in polypharmacy for those ages 45+
• Reported in only ~25% of initial ART trials, and underassessed in routine care, so underappreciated
Gifford AL, et al. J Acquir Immune Defic Syndr. 2000;23(5):386-395; Presented by DAD study group at IAC. July 2010. Vienna, Austria. Hasse B, et al. Clin Infect Dis. 2011;53(11):1130-1139; Krentz HB, et al. Antivir Ther. 2012;17(5):833-840; Presented by Lee, et al. ADAP Data Report Workshop. 2012; Presented by Shahmanesh M, et al. ADAP Data Report Workshop. 2013.
Key Principles
When and Who• Pre-ART and pre-ART change in all patients• On ART
– every patient once stable (about 3 months)– test interval variable and proportional to ART type and to underlying risk in
individual patient– don’t order a test
if you don’t know what to do with the result if the result will not change management
• So, likely that most useful screening will be most useful in older HIV+ adults