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3 June 2014 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

1. Men with HIV have a greater risk and extent of coronary artery disease

Men with HIV have a greater risk for coronary artery disease (CAD) and have more severe disease than uninfected men, according to an article being published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M14-1754). Patients with HIV are living longer and, as such, are experiencing more chronic noninfectious age-related diseases such as CAD. Data has suggested a connection between HIV infection or its treatment and CAD, but the data are inconsistent. Researchers used cardiac computed tomography (CT) to measure coronary artery calcium and coronary CT angiography to assess plaque extent and characteristics in HIV-infected men and a control group. The control group consisted of uninfected men with similar demographics (age and race), CAD risk factors, and lifestyle (men who have sex with men) to the study patients. Even after adjusting for demographic variables and known risk factors for CAD, the men with HIV had a greater prevalence and extent of noncalcified plaque, the kind that is more prone to rupture, potentially leading to heart attacks. Men with more advance HIV infection and a greater number of years on antiretroviral therapy had a higher prevalence of clinically significant coronary stenosis greater than 50 percent. The authors suggest an effort to address and reduce traditional cardiovascular risk factors to improve long-term outcomes for HIV-infected men.

2. Nearly a third of patients fail to fill first-time prescriptions

Nearly a third of patients fail to fill first-time prescriptions, which may be important in determining clinical outcomes, according to an article published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-1705). Many chronic illnesses can be successfully managed with pharmaceutical interventions, but nonadherence to prescribed medications is an issue. Researchers studied 15,961 patients in a primary care network of 131 physicians to estimate the incidence of primary nonadherence (failure to fill a first-time prescription) and association of drug, patient, and physician with nonadherence. The researchers found nearly one third of all initial drug prescriptions were not filled within 9 months. Nonadherence was highest for expensive drugs and chronic preventive therapies for conditions such as ischemic heart disease and depression. Prescriptions for antibiotics were most likely to be filled. Patients with higher copayments, recent hospitalization, and more severe comorbid conditions were at greater risk for nonadherence. Patients that had more visits with the prescribing physician were more likely to fill their prescriptions. The authors suggest that lower copayments and greater follow-up care with prescribing physicians may reduce the risk for nonadherence.

3. Study questions accuracy of results reported on government database and peer-review journals

Discrepancies are common between results reported on the ClinicalTrials.gov results database and those published in peer-reviewed medical journals, according to a study published in Annals of Internal Medicine (http://www.annals.org/article.aspx?doi=10.7326/M13-0480). Clinical trial results may be selectively reported in medical journals. ClinicalTrials.gov is a clinical trial registry developed to provide the public with a Web-based, searchable source of information about trials but validity of posted results is unclear. Researchers looked at a random sample of 110 phase 3 or 4 trials completed before January 2009 to assess the consistency of results reported on the registry and those published in matching peer-reviewed medical journals. Of the trials studied, 20 percent inconsistently reported the primary outcome result. However, only a few of those inconsistencies were potentially meaningful. Descriptions of primary outcomes were inconsistent 15 percent of the time, while 80 percent of trials contained a secondary outcome reporting discrepancy. Adverse events were reported inconsistently in more than one third of trials with fewer serious adverse events being reported in published articles than on ClinicalTrials.gov. The authors write that data entry errors may be to blame for some inconsistencies. Other inconsistencies may take shape during the peer review process where modifications in how results are analyzed or reported could contrast with data submitted to the ClinicalTrials.gov results registry. The authors suggest that until there is a gold standard clinical trial reporting source, discrepancies will have to be clarified by the investigator.