Okeke Nwora Lance, Schafer Katherine R, Meissner Eric G, Ostermann Jan, Shah Ansal D, Ostasiewski Brian, Phelps Evan, Kieler Curtis A, Oladele Eniola, Garg Keva, Naggie Susanna, Bloomfield Gerald S, Bosworth Hayden B
Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.
Division of Infectious Diseases, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Open Forum Infect Dis. 2020 Aug 21;7(9):ofaa361. doi: 10.1093/ofid/ofaa361. eCollection 2020 Sep.
The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear.
PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non-high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance.
Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75-0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88-1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68-1.15).
Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV.
临床医生专业对艾滋病毒感染者（PWH）心血管疾病危险因素结局的影响尚不清楚。
2014年1月至2016年12月在美国东南部3家学术性艾滋病毒诊所接受治疗的PWH，根据管理其高血压或高脂血症的临床医生专业，回顾性地分为5组。对患者进行随访，直至首次发生动脉粥样硬化性心血管疾病事件、死亡或研究结束。感兴趣的结局分别是达到美国国家联合委员会（JNC-8）的血压（BP）目标以及美国国家脂质协会（NLA）针对高血压和高脂血症的非高密度脂蛋白（HDL）目标。使用具有稳健误差方差的修正泊松回归生成相关危险因素的点估计值。
在分析的1667名PWH中，965人患有高血压，205人患有高脂血症，497人同时患有这两种疾病。研究开始时，患者的中位年龄为52岁，66%为黑人，65%为男性。在患有高血压的人群中，24%仅由传染病（ID）临床医生管理，5%由ID临床医生和初级保健临床医生（PCC）共同管理。在观察期结束时，由ID临床医生管理的患者达到JNC-8高血压目标的可能性低于队列中的其他患者（相对风险[RR]，0.84；95%置信区间[CI]，0.75-0.95），但考虑平均研究血压时由ID临床医生管理的患者与队列中的其他患者之间没有差异（RR，0.96；95%CI，0.88-1.05）。管理高脂血症的ID临床医生与达到NLA非HDL目标之间没有显著关联（RR，0.89；95%CI，0.68-1.15）。
临床医生专业可能在艾滋病毒感染者高血压结局欠佳方面发挥作用。
