In an article published in the Archives, Butt et al1 reported an association between human immunodeficiency virus (HIV) infection and heart failure in a retrospective cohort of veterans with no coronary heart disease (CHD) at the baseline. In addition, the magnitude of the association was even stronger for HIV infection than for traditional risk factors, except hypertension and diabetes. The authors have used previously validated criteria to define heart failure, CHD, HIV infection, hypertension, and diabetes,2 based on codes of the International Classification of Diseases, Ninth Revision (ICD-9) attributed to inpatient and/or outpatient diagnoses. As reported in previous studies, there was a reasonable agreement of these definitions with medical records and/or laboratory test–based diagnoses.3 Hypertension is one of the most important risk factors for heart failure, and adherence to lipid-lowering antihypertensive drugs is inversely associated with alcohol consumption and illicit drug use, risk factors for HIV infection.4 Butt et al1 have found a greater prevalence of hypertension and diabetes among noninfected patients than infected ones. The validity between the ICD-9 and the information coded seems to be poor, especially in subjects with multiple diagnostics.5 Therefore, using the ICD-9 codes to define hypertension and diabetes, Butt et al1 might have not avoided biases, especially among HIV-infected patients. Moreover, the high prevalence of illicit drug use and dependence among HIV-infected subjects might be associated with a low rate of treatment and control of hypertension and diabetes. In addition, these comorbidities have been associated with metabolic abnormalities in patients receiving highly active antiretroviral treatment, which was not assessed as a potential confounding factor. Back to top Article Information Correspondence: Mr de Melo Neto, Postgraduate Studies Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2600, Porto Alegre, RI 90035-003, Brazil (email@example.com). Financial Disclosure: None reported. References 1. Butt AA, Chang CC, Kuller L, et al. Risk of heart failure with human immunodeficiency virus in the absence of prior diagnosis of coronary heart disease. Arch Intern Med. 2011;171(8):737-74321518940PubMedGoogle ScholarCrossref 2. Butt AA, Khan UA, McGinnis KA, Skanderson M, Kent Kwoh C. Co-morbid medical and psychiatric illness and substance abuse in HCV-infected and uninfected veterans. J Viral Hepat. 2007;14(12):890-89618070293PubMedGoogle Scholar 3. Butt AA, Xiaoqiang W, Budoff M, Leaf D, Kuller LH, Justice AC. Hepatitis C virus infection and the risk of coronary disease. Clin Infect Dis. 2009;49(2):225-23219508169PubMedGoogle ScholarCrossref 4. Do NT, Phiri K, Bussmann H, Gaolathe T, Marlink RG, Wester CW. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses. 2010;26(6):685-69120518649PubMedGoogle ScholarCrossref 5. Surján G. Questions on validity of International Classification of Diseases –coded diagnoses. Int J Med Inform. 1999;54(2):77-9510219948PubMedGoogle ScholarCrossref
Archives of Internal Medicine – American Medical Association
Published: Oct 24, 2011
Keywords: hiv,hypertension,heart failure
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