Coronary Artery Disease in HIV Patients: Are we Meeting Guidelines?

Background: Cardiovascular disease (CVD) has a higher incidence in patients with HIV infection, though it remains unclear whether patients with HIV presenting with ischaemic heart disease are being adequately managed. We sought to determine whether HIV-infected patients with established CVD were being managed according to National Guidelines.
Methods: Primary care physicians with a special interest in HIV infection were asked to complete a questionnaire for their HIV-infected patients with established CVD, addressing the management of biopsychosocial risk factors. We assessed overall adherence to screening and follow-up recommendations as suggested by The National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand.
Results: Data were collected from Australian general practitioners for 77 HIV-infected patients with a median age of 59 (54-64). There was good adherence to guidelines with regards to anti-platelet (84%) and statin therapy (97%), despite a failure to meet cholesterol targets, with only 24% of the cohort meeting LDL target values. Similarly, there was limited adherence to guidelines regarding; the prescriptions of medications for those with established hypertension (66%), body-mass index (40%), and depression screening (32%).
Conclusions: This Australian audit provides unique insight into adherence to National Guidelines for individuals with CVD and HIV and suggests current screening and management practices for these patients’ falls short of guidelines. It remains unclear how well guidelines are being adhered to in the general population and whether improving adherence improves outcomes.