No re-imbursement for statins, fibrates, and omega-3 derivatives for HIV-infected patients with HAART-related dyslipidaemia in Italy
Abstract number: 1733_1402
Manfredi R., Calza L.
Introduction: The significant HAART-prompted advances achieved in the management of HIV disease may be frustrated by the modified reimbursement modalities of all lipid-lowering drugs (LLD) available in Italy. The remarkably increased life expectancy attained thanks to HAART, is borne by significant risks to develop an uncontrolled hypercholesterolaemia and/or hypertriglyceridaemia, often concomitant with insulin resistance and visceral adiposity, which strongly predispose to cardiovascular events and stroke.
Methods and Results: The present prescribing rules of LLD based on a computer-generated score, were matched with the present situation of around 1000 HIV-infected patients (p) treated with HAART, to assess the frequency and type of dyslipidaemia, and the estimated rate of need of LLD prescriptions. The rate of hypertrigyceridaemia and hypercholesterolaemia exceeded 28% and 19% of p respectively, while around 22% of p had a mixed dyslipidaemia. Over 200 p were currently treated with statins and/or fibrates, with the eventual adjunct of omega-3 fatty polyunsaturated acids (PUFA). When applying the risk score proposed for the general population, <10% of these p reached the threshold of a >20% risk of major vascular events in the next decade (due to the proportionally lower mean age, the absence of familial dyslipidaemia, diabetes, elevated systolic pressure, and anti-hypertension therapy, vs. the general population), while only very few p needed a secondary prophylaxis, due to a prior, major cardio-cerebro-vascular accident. As a result, more than 90% of HIV-infected p presently treated with LLD due to present antiretroviral therapy recommendations have lost all rights to LLD re-imbursement in Italy, and are at serious risk to give up LLD due to not sustainable linked costs.
Discussion: The recent dispositions of the Italian Health Care System ignore the situation of HIV-infected p, who are exposed to a frequent, severe, drug-induced dyslipidaemia, and an elevated major vascular risk despite their lower mean age, and the lack of multiple generic risk factors. At mid-term, the majority of HAART-induced benefits might be blunted by the sudden lack of LLD re-imbursement, which is estimated to regard most of treated HIV-infected p. A comparison with LLD re-imbursement facilities in other countries is also warranted, to draw some epidemiologic and pharmacoeconomic issues suggesting a re-extension of reimbursement facilities of these life-saving drugs to HIV-infected p.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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