final program.qxd - Parallels Plesk Panel

PP 4.12
Significant modification of administrative re-imbursement facilities of all lipid-lowering
drugs in Italy. No consideration of HIV-infected patients with HAART-related
dyslipidemia, who loss their right to a re-imbursed access to statins, fibrates, and
omega-3 derivatives
Roberto Manfredi, Leonardo Calza
Infectious Diseases, University of Bologna, Italy
Introduction
The significant HAART-prompted advances achieved in the management of HIV disease
are at risk to be frustrated by the modified re-imbursement 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 a diet- and exercise-uncontrolled
hypercholesterolemia and/or hypertriglyceridemia, often concomitant with insulin
resistance and visceral adiposity, factors which strongly predispose to cardiovascular
events and stroke.
Patients and Methods
The novel prescribing rules of LLD based on a computer-generated score, were matched
with the present situation of around 1,000 HIV-infected patients (p) treated with HAART, in
order to assess the frequency and type of dyslipidemia, and the estimated rate of need of
LLD prescriptions.
Results
The rate of hypertrigyceridemia and hypercholesterolemia exceeded 28% and 19% of p
respectively, while around 22% of p had a mixed dyslipidemia. 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, less than 10% of these p reached the threshold of a above 20% risk of a major
vascular event in the next decade (due to the proportionally lower mean age, the
absence of familial dyslipidemia, diabetes mellitus, elevated systolic pressure, and
anti-hypertension therapy, compared with the general population), while only very few p
needed a secondary prophylaxis, due to a prior, major cardiovascular or cerebrovascular
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.
POSTERS
Conclusions
The recent dispositions of the Italian Health Care System absolutely ignore the situation
of HIV-infected p, who are exposed to a frequent, severe, drug-induced dyslipidemia, 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 the
majority of treated HIV-infected p. A comparison with LLD re-imbursement facilities in
other countries is also warranted, to draw some epidemiological and pharmacoeconomic
elements suggesting a re-extension of re-imbursement facilities of these life-saving drugs
to HIV-infected p.
“ Focusing FIRST on PEOPLE “ 193 w w w . i s h e i d . c o m