Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

Sergio Serrano-Villar; José Moltó-Marhuenda; Marta Montero-Alonso; Cesar Diaz-Torné; María López-Cavanillas; Leopoldo Pérez de Isla

doi:10.1016/j.eimce.2023.07.009

Knowledge, attitudes and practices in HIV-related chronic inflammation and cardiovascular risk in Spain

Enferm Infecc Microbiol Clin (Engl Ed). 2023 Nov 7:S2529-993X(23)00261-7. doi: 10.1016/j.eimce.2023.07.009. Online ahead of print.

Authors

Sergio Serrano-Villar¹, José Moltó-Marhuenda², Marta Montero-Alonso³, Cesar Diaz-Torné⁴, María López-Cavanillas⁵, Leopoldo Pérez de Isla⁶

Affiliations

¹ Department of Infectious Diseases, Ramon y Cajal Hospital and IRYCIS, Madrid, Spain; Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain. Electronic address: sergio.serrano@salud.madrid.org.
² Centro de Investigación en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Diseases Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Fight AIDS and Infectious Diseases Foundation, Badalona, Barcelona, Spain.
³ Infectious Diseases Unit, La Fe University Hospital, Valencia, Spain.
⁴ Rheumatology Department, Sant Pau i Santa Creu Hospital, Barcelona, Spain.
⁵ Medical Affairs HIV, Gilead Sciences, Madrid, Spain.
⁶ Cardiology Department, San Carlos Clinic Hospital, Universidad Complutense, Madrid, Spain.

PMID: 37945466
DOI: 10.1016/j.eimce.2023.07.009

Abstract

Background: People with HIV (PWH) in suppressive antiretroviral treatment suffer from chronic inflammation-related comorbidities, mainly cardiovascular diseases. However, given the lack of specific evidence about inflammation in PWH, clinical guidelines do not provide recommendations for the management of this issue. To date, physician awareness of inflammation in PWH remains unclear. We analyzed the knowledge, attitudes, and practices (KAP) related to inflammation, particularly in the clinical management of PWH, of infectious disease specialists (IDS)/internists compared to other specialists treating inflammation directly (rheumatologists) or its cardiovascular consequences (cardiologists).

Methods: A committee of IDS/internists treating PWH, cardiologists, and rheumatologists designed the KAP questionnaire. The survey was completed by 405 participants (135 physicians per specialty) stratified by Spanish geography, hospital size, and number of PWH under care (IDS/internists only).

Results: IDS/internists treating PWH scored higher than cardiologists and rheumatologists on knowledge of inflammation (5.5±1.4 out of 8 points vs. 5.2±1.3 and 4.6±1.4 points, respectively; p<0.05). Nevertheless, rheumatologists showed the most proactive attitude toward inflammation (i.e., biomarkers monitoring, anti-inflammatory drug prescription and cardiologist referral), followed by cardiologists and IDS/internists (13±3 of a total of 16 points vs. 11±3 and 10±3.3 points, respectively; p<0.05), irrespective of hospital size and years of experience. Most IDS/internists (59%) include inflammation in their therapeutic recommendations. However, in IDS/internists treating PWH, we observed a negative correlation between years of experience and concern about the clinical consequences of inflammation.

Conclusion: Our findings show that, compared to other specialists, infectious disease specialists/internists have high knowledge about inflammation in HIV infection, but, in the absence of scientific evidence to base their decisions on inflammatory markers, the therapeutic implications are scarce. The results support the need for more evidence on the monitoring and treatment of inflammation in PWH.

Keywords: Actitudes; Attitudes; Cardiovascular risk; Chronic inflammation; Clinical practice; Conocimientos; Cuestionario; HIV; Inflamación crónica; Knowledge; Práctica clínica; Questionnaire; Riesgo cardiovascular; VIH.