Abstract | Background:
Cardiovascular disease (CVD) is expected to contribute a large noncommunicable disease burden among human immunodeficiency virus (HIV)-infected people. We quantify the impact of prevention interventions on annual CVD burden and costs among HIV-infected people in the Netherlands. Methods: We constructed an individual-based model of CVD in HIV-infected people using national ATHENA ( AIDS Therapy Evaluation in The Netherlands) cohort data on 8791 patients on combination antiretroviral therapy (cART). The model follows patients as they age, develop CVD (by incorporating a CVD risk equation), and start cardiovascular medication. Four prevention interventions were evaluated: (1) increasing the rate of earlier HIV diagnosis and treatment; (2) avoiding use of cART with increased CVD risk; (3) smoking cessation; and (4) intensified monitoring and drug treatment of hypertension and dyslipidemia, quantifying annual number of averted CVDs and costs. Results: The model predicts that annual CVD incidence and costs will increase by 55% and 36% between 2015 and 2030. Traditional prevention interventions (ie, smoking cessation and intensified monitoring and treatment of hypertension and dyslipidemia) will avert the largest number of annual CVD cases (13.1% and 20.0%) compared with HIV-related interventions-that is, earlier HIV diagnosis and treatment and avoiding cART with increased CVD risk (0.8% and 3.7%, respectively)-as well as reduce cumulative CVD-related costs. Targeting high-risk patients could avert the majority of events and costs. Conclusions: Traditional CVD prevention interventions can maximize cardiovascular health and defray future costs, particularly if targeting high-risk patients. Quantifying additional public health benefits, beyond CVD, is likely to provide further evidence for policy development.
|
Authors | Mikaela Smit, Rosan A van Zoest, Brooke E Nichols, Ilonca Vaartjes, Colette Smit, Marc van der Valk, Ard van Sighem, Ferdinand W Wit, Timothy B Hallett, Peter Reiss, Netherlands AIDS Therapy Evaluation in The Netherlands (ATHENA) Observational HIV Cohort |
Journal | Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
(Clin Infect Dis)
Vol. 66
Issue 5
Pg. 743-750
(02 10 2018)
ISSN: 1537-6591 [Electronic] United States |
PMID | 29029103
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
|
Copyright | © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: [email protected]. |
Topics |
- Adult
- Aging
- Cardiovascular Diseases
(economics, epidemiology, prevention & control)
- Cohort Studies
- Cost of Illness
- Female
- HIV Infections
(complications, drug therapy, epidemiology)
- Homosexuality, Male
- Humans
- Incidence
- Male
- Middle Aged
- Models, Theoretical
- Morbidity
- Netherlands
(epidemiology)
- Risk Factors
- Sexual and Gender Minorities
|