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Aspirin use for MI prevention low among people with HIV
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The use of aspirin for prevention of myocardial infarction was lower among people with HIV compared with controls, according to researchers from Massachusetts General Hospital.
“The driver of lower rates of aspirin use among HIV-infected patients is unclear,” the researchers wrote in Open Forum Infectious Diseases. “One possible reason for the discrepancy is the lack of [coronary heart disease] prevention guidelines specific to the HIV population. This discrepancy … could also reflect a generalized under emphasis by HIV providers on non-infectious chronic disease complications of HIV in the earlier years … of the study.”
The researchers conducted a cross-sectional study that included 4,037 patients with HIV and 36,338 matched controls with no known CHD. They developed an algorithm to determine non-episodic aspirin use rates, which used medication data and notes from electronic health records (EHRs). When validated by physician chart review, the algorithm had 73% sensitivity and 83% specificity. The researchers also evaluated aspirin use among patients with known CHD: 410 with HIV and 3,336 without.
In the overall group, the rate of aspirin use was lower in the patients with HIV: 12.4% vs. 15.3% (P<.001). It was also lower among men: 13.1% vs. 17.3% (P<.001). In an age-stratified analysis, the rate of aspirin use among people with HIV was lower in those aged 30 to 39 years and 40 to 49 years, but higher among men with HIV older than 70 years.
Aspirin use was also lower for people with HIV in both the high CV risk and the low CV risk groups. The difference was greater in the high-risk group and was seen among men and women. For patients with HIV, aspirin use rates were significantly higher among patients with a nadir CD4 count of less than 200 cells/mcL in the overall group and among women.
Among the patients with CHD at the start of the study, aspirin use was also lower among people with HIV: 51.6% vs. 65.4% (P<.001). This was true among men and women. According to age, aspirin use was lower among people with HIV aged 18 to 39 years, 40 to 49 years and 50 to 59 years.
“The low rates observed among both HIV-infected and HIV-uninfected patients may reflect underuse of this treatment modality which has been demonstrated for the general population,” the researchers wrote. “However, the underlying reasons for low rates of aspirin use for secondary prevention in the general population remain unknown. There is a clear need for targeted interventions to increase aspirin use in this high risk population of both HIV-infected and HIV-uninfected patients.”
Disclosure: One researcher has received research support from Amgen, Bristol-Myers Squibb, Gilead and Theratechnologies.
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