Lower Lipid Screening Rate among HIV Positive Outpatients in an Urban ClinicGordana Simeunovic, MD; Leonard Johnson, MD; Susan Szpunar, PhD; Louis Saravolatz, MD

Department of Internal MedicineSt. John Hospital and Medical Center, Detroit Michigan

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Objectives• To evaluate compliance with lipid screening guidelines among HIV-

positive patients (cases) by Infectious Diseases (ID) physicians compared to non-HIV controls managed by Internal Medicine (IM) physicians; and

• To determine whether screening rates among HIV patients was influenced by having a primary care provider.

Methods• Retrospective case control study of HIV patients seen by ID

physicians (cases) compared to age and gender matched (1:1) non-HIV patients seen by IM specialists between 1/1/11 and 12/31/11.

• Exclusion criteria: age<20 and <2 visits during the study period• Data were collected onwhether screening was ordered and

performed, and if it was compliant with USPSTF lipid profile screening guidelines based on age, gender and presence of cardiovascular risk factors. For cases, we also collected data on presence of a primary care provider (PCP) and use of antiretroviral therapy.

• Statistical analysis was done by chi-squared analysis and Student’s t-test; p<0.05 was considered to indicate statistical significance.

Introduction • As a result of advances in antiretroviral therapy, non-HIV related

conditions including cardiovascular diseases are gradually becoming the leading causes of morbidity and mortality in patients with HIV.

• Thus, appropriate lipid screening is increasingly important in the outpatient care of HIV patients.

ResultsTable. Screening rate among HIV patients based on having PCP

Results•The study included 153 HIV positive patients (cases) and 152 age and gender matched HIV negative patients (controls).

•There were no significant differences in age and gender by study groups.•ID physicians were complaint with lipid profile screening guidelines in 60.1% of cases, which was significantly lower (p<0.0001) then in IM group where physicians were compliant in 78.9%. (Figure 1)

Figure 1. Compliance ratesof Lipid screening

• From seven included CVD risk factors, 3 were significantly higher in HIV population: tobacco abuse (p<0.0001), hypertension defined by increased blood pressure (p<0.013) and non-coronary atherosclerosis (p<0.030) (Figure 2)

Figure 2. Comparison ofCVD Risk factors

ConclusionsInfectious diseases physician compliance with lipid profile screening guidelines is significantly lower then IM physician compliance in non-HIV controls despite increased risk factors for CVD. This was true even if patients had a PCP.

Recommendations• Educate physicians involved in HIV care about current lipid

screening guidelines• Periodic reviews of compliance with lipid screening among HIV

patients• Encourage use of electronic tools among ID physicians for tracking

health maintenance goals

gordana.simeunovic@stjohn.org19251 Mack Ave, Suite 333Grosse Pointe Woods, MI 48236313-343-3802 office313-343-7840 fax

PCPYes No P-value

ID Compliant 61.9%(60/97)

57.1%(32/56)

0.566

Non-compliant 38.1% (37/97)

42.9% (24/56)

51%

31.4%

3.9%7.2%

25.7%19.1%

9.2%

2%0

10

20

30

40

50

60

Tobacco Use HTN defined by↑ BP

Fam Hx.Premature CAD

Non-coronaryAtherosclerosis

HIV (cases)IM (controls)p<0.0001 p=0.013

p=0.06 p=0.03

55.6% 54.2%60.1%64.5%

56.6%

78.9%

0

20

40

60

80

100

Lipid Profile Ordered Lipid Profile Done Compliantw/guidelines

HIV (cases)IM (controls)

p=0.11 p=0.68

p<0.0001