Lipid Screening

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		Performance Measure
		Numerator
		Denominator
		Patient Exclusions
		Data Element
		Data Sources
		National Goals, Targets or Benchmarks for Comparison
		Outcome Measures for Consideration
		Basis for Selection and Placement in Group 2
		US Public Health Service Guidelines
		References/Notes

Percentage of clients with HIV infection on HAART who had a fasting lipid panel [ 1 ] during the measurement year .

Number of HIV-infected clients who:

• were prescribed HAART, and
• had a fasting lipid panel in the measurement year

Number of HIV-infected clients who are on HAART and who had a medical visit with a provider with prescribing privileges [ 2 ] at least once in the measurement year

None

1. Is the client HIV-infected? (Y/N)
   1. If yes, was the client on HAART?(Y/N)
      1. If the client was on HAART, did he/she have a fasting lipid panel during the measurement year? (Y/N)

• Electronic Medical Record/Electronic Health Record
• CAREWare, Lab Tracker, or other electronic data base
• HIVQUAL reports on this measure for grantee under review
• Medical record data abstraction by grantee of a sample of records

National HIVQUAL Data [ 3 ]

	2003	2004	2005	2006
Top 10%	100.0%	100.0%	100.0%	100.0%
Top 25%	100.0%	100.0%	97.9%	100.0%
Mean*	80.7%	79.1%	80.2%	84.7%

*from HAB data base

• Incidence of cardiovascular events in clinic population
• Incidence of metabolic syndrome in the clinic population

Changes in body shape, fat distribution & metabolism occur with frequency among HIV-infected patients, particularly those prescribed HAART. Metabolic changes that have been observed include hypertriglyceridemia, low high-density-lipoprotein (HDL) cholesterol and changes in LDL cholesterol.

Although rates of prevalence vary, studies have found the rate of prevalence for metabolic syndrome to be almost 25% in a population of patients taking HAART [ 4 ], where metabolic syndrome is defined as the presence of at least 3 of the following: hypertriglyceridemia, low high-density lipoprotein cholesterol, hypertension, abdominal obesity or high serum glucose. [ 5 ]

All patients should receive a lipid profile at least once a year in order to monitor general health. For patients on HAART, lipid level monitoring is important to detect side effects and to identify patients who may require treatment.

Measure reflects important aspect of care that impacts HIV-related morbidity and focuses on treatment decisions that affect a sizable population. Measure has a strong evidence base supporting the use.

As part of pretreatment evaluation: "The following laboratory tests should be performed for each new patient during initial patient visits:…and serum lipids if considered at risk for cardiovascular disease and for baseline evaluation prior to initiation of combination antiretroviral therapy (AIII)…." [ 6 ]

[1] A fasting lipid panel consists of fasting cholesterol, HDL, calculated LDL and triglycerides.

[2] A "provider with prescribing privileges" is a health care professional who is certified in their jurisdiction to prescribe ARV therapy.

[3] (http://www.hivguidelines.org/admin/files/qoc/hivqual/proj%20info/HQNatlAggScrs3Yrs.pdf) The HIVQUAL indicator includes all patients on ARV therapy.

[4] Jacobson DL, Tang AM, Spiegalman D. Incidence of Metabolic Syndrome in a Cohort of HIV-Infected Adults and Prevalence Relative to the US Population (National Health and Nutrition Examination Survey). J Acquir Immune Defic Syndr. 2006 Sep 14.

[5] Jacobson DL, Tang AM, Spiegalman D. Incidence of Metabolic Syndrome in a Cohort of HIV-Infected Adults and Prevalence Relative to the US Population (National Health and Nutrition Examination Survey). J Acquir Immune Defic Syndr. 2006 Sep 14 .

[6] Panel on Antiretroviral Guidelines for Adult and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-Infected Adults and Adolescents. Department of Health and Human Services. January 29, 2008, p. 3, 82. Available at http://aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf ) Accessed April 2, 2008.