🏳️‍🌈✝️🔻 The Link Between HIV and High Blood Pressure

"To the extent that practitioners of both HIV care and general internal medicine know there's an association between HIV and high blood pressure, the better we all are for it, the better our patients will be for it." 

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FRIDAY, May 18, 2018 (American Heart Association) -- People with HIV are more likely than people without the virus to have high blood pressure, in part because of treatments and repercussions of the condition itself, a new review of research shows.

Learning more about the underlying mechanisms of high blood pressure in people with HIV is critical in preventing one of the leading conditions that can cause premature cardiovascular disease in those adults, the researchers said. The implications are important in a population that has seen the rate of people dying from heart disease and stroke skyrocket over the last decade.
"I think that we really need to pay special attention to this population," said Dr. Sasha Fahme, the study's lead author and a global health research fellow at Weill Cornell Medical College in New York City. "Now that people [with HIV] are living longer, we are seeing the non-infectious consequences of HIV, and hypertension [high blood pressure] is one of them."
In the Weill Cornell Medicine-led research review, published May 18 in the American Heart Association journal Hypertension, Fahme and her colleagues included 24 medical articles published between 2005 and 2017 that looked at high blood pressure among adults with HIV and those who didn't have the virus. The study populations included the United States, Brazil, China, Italy, Tanzania and other countries.

The analysis centered on vascular inflammation, intestinal problems, high cholesterol, HIV-related kidney disease and other conditions present with HIV that appear to be strongly linked to high blood pressure.

Because their immune system is constantly active, people with HIV have chronic inflammation in their arteries, which may make them stiff and enlarged, said Fahme, whose research includes high blood pressure in HIV patients in Tanzania.

In addition, antiretroviral medications appear to trigger conditions that lead to inflammation. Yet people who have been able to suppress the virus to the point where doctors can't detect it also suffer from inflammation, Fahme said.

And chronic inflammation also may be linked to gut bacteria, the scientists said in their review.

Research has shown HIV attacks cells in the intestinal wall, creating holes in the lining that allow bacteria to get through it, Fahme and her colleagues said in their article. That possibly creates "a complex relationship between hypertension, the gut microbiome and immune activation."

A kidney condition linked to high blood pressure appears to be four times greater in people with HIV -- and also may be linked to chronic inflammation, according to the new study. People with HIV appear to have much higher rates of the condition characterized by high levels of a protein found in urine.

Studies also suggest HIV-related high cholesterol may lead to high blood pressure. In turn, the researchers in the new study say lipid disorders in people with HIV may be linked to low levels of hormones that regulate blood sugar and break down fat. The different kinds of cholesterol and other fats in the blood are called lipids.

Dr. Lance Okeke, an infectious disease doctor who treats HIV patients in Durham, N.C., said the new study is a comprehensive review and an important addition to the existing literature because it aims to understand why people with the virus have risk factors for heart disease and stroke.

The analysis suggests mechanisms in the immune system are strongly linked to high blood pressure, said Okeke, a researcher at Duke University School of Medicine, who was not involved in the new research. "I think that the theme that stood out was potentially using HIV as a platform, as a model to study hypertension overall."

The results are "hopeful because we actually do have relatively blunt but effective tools for [treating] chronic inflammation and immune activation," he said. Okeke was the lead author of a recent study that found the rate of new high blood pressure diagnoses in people with HIV increased between 1996 and 2013.

To successfully stave off heart disease and stroke in patients with HIV, Okeke's study said it was important for doctors to diagnose HIV early and to aggressively treat high blood pressure and other conditions that may lead to cardiovascular disease.

That's where primary care doctors and infectious disease specialists play a critical role, Okeke said.

"There can't be enough education about the fact that persons living with HIV are at higher risk for coronary disease," he said. "To the extent that practitioners of both HIV care and general internal medicine … know there's an association [between HIV and high blood pressure], the better we all are for it, the better our patients will be for it."

Last Updated: May 18, 2018
Copyright is owned or held by the American Heart Association, Inc., and all rights are reserved.

🏳️‍🌈✝️🔻 Here’s the real State of the Union

The Gayly

02/06/2019

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“For more than two years, Donald Trump and Mike Pence have made attacking LGBTQ people and other marginalized communities a top priority of their administration,” said Human Rights Campaign (HRC)  President Chad Griffin. 

“From undermining protections for transgender youth, to threatening to deport Dreamers, to attempting to ban transgender service members from the military, to working to eviscerate health care coverage for those most vulnerable -- this is a presidency rooted in prejudice and fear.

"At every turn, we have put up roadblocks on this administration’s path of destruction and discrimination, uniting with our allies across movements. Now, with a pro-equality majority in the House of Representatives poised to pass the Equality Act and tackle other critical issues, we continue to demonstrate that when we stand together we are a force to be reckoned with.” 

HRC amplified the voices of LGBTQ people impacted by the Trump administration’s hateful agenda in response to the president’s State of the Union address. Here are a few of the responses:

Lt. Col. Bryan Bree Fram, active-duty U.S. Air Force rocket scientist of 16 years:  “Trans service members lace up their boots every day, accomplish the mission and prove again and again that we belong. We’ve faced the same arguments used against the inclusion of every minority group and shown them to be as inaccurate now as ever. 

"We’re focused on protecting the ideals of the constitution we swore to defend; we just wish we didn’t have to do it under the swirling maelstrom of uncertainty that we face today.”

Amber Briggle, a member of HRC’s Parents for Transgender Equality from Texas: “For two years straight, the Trump-Pence administration has targeted my transgender son, and all transgender youth, for discrimination. Donald Trump has laid out an agenda built on fear and hate at a time when young people of every background need their government to have their backs. 

"My child is not a political pawn, and we won’t stop fighting for him and other transgender people until everyone is treated with the respect that they deserve.”

Edgar, Young LGBTQ Dreamer and recent college graduate: "I was raised to be hardworking and to help others, but my ambitions are not possible under an administration that denies me a chance to achieve my dreams and further my education. My parents came to this country to provide me with more opportunities and a better life. 

"As a college-educated and LGBTQ dreamer, I call the United States my home. I am not the exception. I represent a community that believes that we all deserve the right to be who we are, to achieve our dreams and also to serve our country."

HRC applauded the Democratic response to Trump’s speech by Stacey Abrams, recently the Democratic candidate for Governor of Georgia. “What a contrast: Stacey Abrams didn't just give a rebuttal to Trump, she presented the nation with a vision of the future that is grounded in hope, justice, and progress for all Americans. From addressing gun violence to voter suppression, immigration, LGBTQ equality and racism in our country, she outlined the REAL State Of The Union.”

Rolling Stone also covered the SOTU and Abrams’ response, saying, “Trump’s second State of the Union wasn’t much more than a slightly polished version of his campaign rallies, rife with the usual fear-mongering over immigration and accusations that Democrats are un-American for disagreeing with him. 

"The rebuttal from Abrams was anything but a hollow call for unity. The longtime Georgia lawmaker drew on her own experience to drive home a need to reach across the aisle in the name what she sees as non-negotiable American values.

“’For seven years, I led the Democratic Party in the Georgia House of Representatives,’ said Abrams, who became the first person to deliver an official rebuttal to the State of the Union who did not hold federal office. ‘I didn’t always agree with the Republican Speaker or Governor, but I understood that our constituents didn’t care about our political parties — they cared about their lives. 

"'So, when we had to negotiate criminal justice reform or transportation or foster care improvements, the leaders of our state didn’t shut down — we came together. And we kept our word. It should be no different in our nation’s capital. We may come from different sides of the political aisle; but, our joint commitment to the ideals of this nation cannot be negotiable.’”

For other coverage of the speech, check out Logo’s LGBTQ State of the Union featuring the legendary Billy Porter. Watch here.

Read more articles from The Gayly, here

🏳️‍🌈✝️🔻 New Research Shows Changes to the Six Protected Classes Would Harm Most Vulnerable Patients and Are Unnecessary

By: Juliet Johnson, Deputy Vice President of Public Affairs, PhRMA

AIDS DRUG ASSISTANCE PROGRAM

01/31/2019 

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Reprinted with Permission from the Pharmaceutical Research and Manufacturers of America

 

 

 

 

 

In Medicare Part D, the six protected classes policy protects vulnerable seniors and low-income beneficiaries with serious and complex health conditions, while also allowing Part D insurance plans to use the tools they need to control costs. Medicines for some of the sickest patients in Part D are covered within the six protected classes, including those for cancer, epilepsy, HIV/AIDS and mental illness.  Many of these conditions require patients to attempt a variety of therapies before they and their doctor settle on the most appropriate treatment, so there is no one-size fits all medicine for these conditions.

Unfortunately, the Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule that would weaken the six protected classes by allowing Part D plans to restrict access to medicines by: using prior authorization or step therapy for patients already stable on a six protected classes medicine, including patients who are taking HIV/AIDS medicines; excluding a protected class drug if the drug is simply a new formulation regardless of whether the old formulation is still on the market; and excluding a drug from the protected classes if its list price increased more than general inflation.

New data from IQVIA’s US Market Access Strategy Consulting team highlights how plan sponsors are already using the tools they currently have to manage costs and how devastating these changes could be to many seniors and low-income beneficiaries who rely on the six protected classes for their treatment.

Currently, plans have ample opportunity to use utilization management tools to contain costs and influence the medicines new patients begin their treatment with in the protected classes, with the exception of HIV patients. For HIV, CMS historically has not permitted plans to use utilization management for patients new to therapy because “utilization management tools such as prior authorization and step therapy are generally not employed in widely used, best practice formulary models” for HIV (CMS, 2010). Analysis of IQVIA’s longitudinal patient claims data finds that, depending on the class, between 27 percent and 48 percent of patients taking a medicine in one of the five non-HIV protected classes are new to treatment in a given year.

Changes to the six protected classes impact Low Income Subsidy (LIS) patients heavily as they make up a substantial portion of beneficiaries within the six protected classes, particularly within the mental health and HIV/AIDS classes. LIS beneficiaries have limited income and resources so they are eligible for extra help to access their medicines. For example, in 2019, for beneficiaries to be eligible for LIS their annual income is limited to $18,210 for an individual, or $24,690 for a married couple living together. That means for LIS patients it is that much more important that the six protected classes provide access to required medicines for their complex condition because they do not have the disposable income to pay for them without coverage.

IQVIA found that LIS patients represent more than one in four beneficiaries across the protected classes; and for certain classes it can be as high as 65 percent of patients. Therefore, if the changes proposed by CMS were implemented, jeopardizing access to the drugs in the six protected classes, it could have devastating consequences for literally the most vulnerable of the most vulnerable Part D beneficiaries.

Enabling plans to limit access to the medicines that patients rely on would weaken the six protected classes to such an extent that the classes could no longer be considered truly “protected.” Plans are already effectively using the tools they have, making it unnecessary to enact changes that would jeopardize access for the most vulnerable of the sickest patients in Part D.

References:

• CMS, Medicare Prescription Drug Benefit Manual, Ch. 6, 30.2.5 (Feb. 19, 2010)