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Soares C, Kwok M, Boucher KA, Haji M, Echouffo-Tcheugui JB, Longenecker CT, Bloomfield GS, Ross D, Jutkowtiz E, Sullivan JL, Rudolph JL, Wu WC, Erqou S. Performance of Cardiovascular Risk Prediction Models Among People Living With HIV: A Systematic Review and Meta-analysis. JAMA Cardiol 2023; 8:139-149. [PMID: 36576812 PMCID: PMC9857084 DOI: 10.1001/jamacardio.2022.4873] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/20/2022] [Indexed: 12/29/2022]
Abstract
Importance Extant data on the performance of cardiovascular disease (CVD) risk score models in people living with HIV have not been synthesized. Objective To synthesize available data on the performance of the various CVD risk scores in people living with HIV. Data Sources PubMed and Embase were searched from inception through January 31, 2021. Study Selection Selected studies (1) were chosen based on cohort design, (2) included adults with a diagnosis of HIV, (3) assessed CVD outcomes, and (4) had available data on a minimum of 1 CVD risk score. Data Extraction and Synthesis Relevant data related to study characteristics, CVD outcome, and risk prediction models were extracted in duplicate. Measures of calibration and discrimination are presented in tables and qualitatively summarized. Additionally, where possible, estimates of discrimination and calibration measures were combined and stratified by type of risk model. Main Outcomes and Measures Measures of calibration and discrimination. Results Nine unique observational studies involving 75 304 people (weighted average age, 42 years; 59 490 male individuals [79%]) living with HIV were included. In the studies reporting these data, 86% were receiving antiretroviral therapy and had a weighted average CD4+ count of 449 cells/μL. Included in the study were current smokers (50%), patients with diabetes (5%), and patients with hypertension (25%). Ten risk prediction scores (6 in the general population and 4 in the HIV-specific population) were analyzed. Most risk scores had a moderate performance in discrimination (C statistic: 0.7-0.8), without a significant difference in performance between the risk scores of the general and HIV-specific populations. One of the HIV-specific risk models (Data Collection on Adverse Effects of Anti-HIV Drugs Cohort 2016) and 2 of the general population risk models (Framingham Risk Score [FRS] and Pooled Cohort Equation [PCE] 10 year) had the highest performance in discrimination. In general, models tended to underpredict CVD risk, except for FRS and PCE 10-year scores, which were better calibrated. There was substantial heterogeneity across the studies, with only a few studies contributing data for each risk score. Conclusions and Relevance Results of this systematic review and meta-analysis suggest that general population and HIV-specific CVD risk models had comparable, moderate discrimination ability in people living with HIV, with a general tendency to underpredict risk. These results reinforce the current recommendations provided by the American College of Cardiology/American Heart Association guidelines to consider HIV as a risk-enhancing factor when estimating CVD risk.
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Affiliation(s)
- Cullen Soares
- Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Michael Kwok
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Kent-Andrew Boucher
- 27th Special Operations Medical Group, US Air Force, US Department of Defense, Cannon Air Force Base, Clovis, New Mexico
| | - Mohammed Haji
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Justin B. Echouffo-Tcheugui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Gerald S. Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, North Carolina
| | - David Ross
- Office of Specialty Care Service, US Department of Veterans Affairs, Washington, DC
- Infectious Disease Section, Washington DC Department of Veterans Affairs Medical Center, Washington, DC
| | - Eric Jutkowtiz
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - Jennifer L. Sullivan
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
| | - James L. Rudolph
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Wen-Chih Wu
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Brown University School of Public Health, Brown University, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
| | - Sebhat Erqou
- Department of Medicine, Brown University, Providence, Rhode Island
- Center of Innovation in Long Term Services & Supports, Providence VA Medical Center, Providence, Rhode Island
- Evidence Synthesis Program Center, Providence VA Health Care System, Providence, Rhode Island
- Department of Medicine, Providence VA Medical Center, Providence, Rhode Island
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Yu J, Liu X, Zhu Z, Yang Z, He J, Zhang L, Lu H. Prediction models for cardiovascular disease risk among people living with HIV: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1138234. [PMID: 37034346 PMCID: PMC10077152 DOI: 10.3389/fcvm.2023.1138234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/08/2023] [Indexed: 04/11/2023] Open
Abstract
Background HIV continues to be a major global health issue. The relative risk of cardiovascular disease (CVD) among people living with HIV (PLWH) was 2.16 compared to non-HIV-infections. The prediction of CVD is becoming an important issue in current HIV management. However, there is no consensus on optional CVD risk models for PLWH. Therefore, we aimed to systematically summarize and compare prediction models for CVD risk among PLWH. Methods Longitudinal studies that developed or validated prediction models for CVD risk among PLWH were systematically searched. Five databases were searched up to January 2022. The quality of the included articles was evaluated by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We applied meta-analysis to pool the logit-transformed C-statistics for discrimination performance. Results Thirteen articles describing 17 models were included. All the included studies had a high risk of bias. In the meta-analysis, the pooled estimated C-statistic was 0.76 (95% CI: 0.72-0.81, I 2 = 84.8%) for the Data collection on Adverse Effects of Anti-HIV Drugs Study risk equation (D:A:D) (2010), 0.75 (95% CI: 0.70-0.79, I 2 = 82.4%) for the D:A:D (2010) 10-year risk version, 0.77 (95% CI: 0.74-0.80, I 2 = 82.2%) for the full D:A:D (2016) model, 0.74 (95% CI: 0.68-0.79, I 2 = 86.2%) for the reduced D:A:D (2016) model, 0.71 (95% CI: 0.61-0.79, I 2 = 87.9%) for the Framingham Risk Score (FRS) for coronary heart disease (CHD) (1998), 0.74 (95% CI: 0.70-0.78, I 2 = 87.8%) for the FRS CVD model (2008), 0.72 (95% CI: 0.67-0.76, I 2 = 75.0%) for the pooled cohort equations of the American Heart Society/ American score (PCE), and 0.67 (95% CI: 0.56-0.77, I 2 = 51.3%) for the Systematic COronary Risk Evaluation (SCORE). In the subgroup analysis, the discrimination of PCE was significantly better in the group aged ≤40 years than in the group aged 40-45 years (P = 0.024) and the group aged ≥45 years (P = 0.010). No models were developed or validated in Sub-Saharan Africa and the Asia region. Conclusions The full D:A:D (2016) model performed the best in terms of discrimination, followed by the D:A:D (2010) and PCE. However, there were no significant differences between any of the model pairings. Specific CVD risk models for older PLWH and for PLWH in Sub-Saharan Africa and the Asia region should be established.Systematic Review Registration: PROSPERO CRD42022322024.
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Affiliation(s)
- Junwen Yu
- School of Nursing, Fudan University, Shanghai, China
| | - Xiaoning Liu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Guangdong, China
- National Heart & Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Zheng Zhu
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
- NYU Rory Meyers College of Nursing, New York University, New York City, NY, United States
- Correspondence: Zheng Zhu Hongzhou Lu
| | - Zhongfang Yang
- School of Nursing, Fudan University, Shanghai, China
- Fudan University Centre for Evidence-Based Nursing: A Joanna Briggs Institute Centre of Excellence, Shanghai, China
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
| | - Jiamin He
- School of Nursing, Fudan University, Shanghai, China
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Department of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Shenzhen Third People's Hospital, Guangdong, China
- Correspondence: Zheng Zhu Hongzhou Lu
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Delabays B, Cavassini M, Damas J, Beuret H, Calmy A, Hasse B, Bucher HC, Frischknecht M, Müller O, Méan M, Vollenweider P, Marques-Vidal P, Vaucher J. Cardiovascular risk assessment in people living with HIV compared to the general population. Eur J Prev Cardiol 2021; 29:689-699. [PMID: 34893801 DOI: 10.1093/eurjpc/zwab201] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/12/2021] [Indexed: 12/16/2022]
Abstract
AIMS We prospectively assessed and compared the accuracy of cardiovascular risk scores in people living with HIV (PLWH) and individuals from the general population. METHODS AND RESULTS The Systematic Coronary Risk Evaluation Score 2 (SCORE2), the Pooled Cohort Equations (PCE), and the HIV-specific Data Collection on Adverse events of Anti-HIV Drugs (D:A:D) score were calculated in participants free from atherosclerotic cardiovascular disease (ASCVD) between 2003 and 2009. In total, 6373 [mean age, 40.6 years (SD, 9.9)] PLWH from the Swiss HIV Cohort Study (SHCS) and 5403 [52.8 years (SD, 10.7)] individuals from the CoLaus|PsyCoLaus study were eligible for analysis. We tested discrimination and calibration, and the value of adding HIV-specific factors to scores using the net reclassification improvement (NRI). During mean follow-ups of 13.5 (SD, 4.1) in SHCS and 9.9 (SD, 2.3) years in CoLaus|PsyCoLaus study, 533 (8.4%) and 374 (6.9%) people developed an incident ASCVD, respectively. This translated into age-adjusted incidence rates of 12.9 and 7.5 per 1000 person-year, respectively. In SHCS, SCORE2, PCE, and D:A:D presented comparable discriminative capacities [area under the receiver operating characteristic curve of 0.745 (95% confidence interval, CI, 0.723-0.767), 0.757 (95% CI, 0.736-0.777), and 0.763 (95% CI, 0.743-0.783)]. Adding HIV-specific variables (CD4 nadir and abacavir exposure) to SCORE2 and PCE resulted in an NRI of -0.1% (95% CI, -1.24 to 1, P = 0.83) and of 2.7% (95% CI, 0.3-5.1, P = 0.03), respectively. CONCLUSIONS PLWH present a two-fold higher rate of incident ASCVD compared to individuals from the general population. SCORE2 and PCE, which are clinically easier to use (reduced set of variables without adding HIV-specific factors), are valid to predict ASCVD in PLWH.
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Affiliation(s)
- Benoît Delabays
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Jose Damas
- Division of Infectious Diseases, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Hadrien Beuret
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Alexandra Calmy
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Barbara Hasse
- Department of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology & Biostatistics, Basel University Hospital, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Manuel Frischknecht
- Division of Infectious Diseases and Hospital Epidemiology, Department of Internal Medicine, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007 St. Gallen, Switzerland
| | - Olivier Müller
- Division of Cardiology, Heart and Vessel Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Marie Méan
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Peter Vollenweider
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Julien Vaucher
- Division of Internal Medicine, Department of Medicine, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
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Grand M, Bia D, Diaz A. Cardiovascular Risk Assessment in People Living With HIV: A Systematic Review and Meta-Analysis of Real-Life Data. Curr HIV Res 2021; 18:5-18. [PMID: 31830884 DOI: 10.2174/1570162x17666191212091618] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND People living with HIV (PLWHIV) have a 2-fold higher risk of having a cardiovascular event than HIV-negative individuals. OBJECTIVE The objective of this article is to estimate the pooled proportion of moderate-high cardiovascular risk in PLWHIV obtained through different scores. In addition, this study also aims to establish the prevalence of dyslipidemia, smoking habits, diabetes and high blood pressure in the included studies. METHODS A bibliographic search was conducted in MEDLINE for studies on cardiovascular risk assessment in PLWHVI that took place during the period of inception to July 2018. The eligibility criteria for inclusion were: cross-sectional or longitudinal studies on HIV-positive adults in which the prevalence of moderate-high cardiovascular risk (or data to calculate it) was reported, and included at least one of the following cardiovascular risk scores: Framingham, ASCVD, D:A:D, Progetto Cuore, PROCAM, SCORE, Regicor, and World Health Organization scores. RESULTS Bibliographic search identified 278 studies. Finally, thirty-nine peer-reviewed publications were identified for a collective total of 13698 subjects. The pooled prevalence of moderate-high cardiovascular risk in PLWHIV obtained with nine different scores through random-effect modeling was 20.41% (95% CI: 16.77-24.31). The most prevalent concomitant cardiovascular risk factor was dyslipidemia (39.5%), smoking (33.0 %), high blood pressure (19.8%) and diabetes (7.24%). CONCLUSION Data obtained in this systematic review indicate that more than 1 in every five subjects with HIV have a moderate-high cardiovascular risk. In consequence, the burden of cardiovascular disease in PLWHIV represents a public health problem. There is an urgent need to develop strategies to prevent and detect cardiovascular risk effectively in PLWHIV.
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Affiliation(s)
- Marina Grand
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina
| | - Daniel Bia
- Departamento de Fisiologia, Facultad de Medicina, Universidad de la Republica, Centro Universitario de Investigacion, Innovacion y Diagnostico Arterial (CUiiDARTE), Universidad de la Republica General Flores 2125, PC 11800 Montevideo, Uruguay
| | - Alejandro Diaz
- Instituto de Investigacion en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Nacional del Centro de la Provincia de Buenos Aires (UNCPBA), Pringles 4375, Olavarría (7400), Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET, Centro Científico Tecnológico Tandil) 4 de abril 618, Tandil (7000), Argentina
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5
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Saumoy M, Di Yacovo S, Pérez S, Sánchez-Quesada JL, Valdivielso JM, Subirana I, Imaz A, Tiraboschi JM, García B, Ordoñez-LLanos J, Benítez S, Podzamczer D, Grau M. Carotid atherosclerosis in virologically suppressed HIV patients: comparison with a healthy sample and prediction by cardiovascular risk equations. HIV Med 2021; 22:581-591. [PMID: 33817938 DOI: 10.1111/hiv.13093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/04/2021] [Accepted: 01/28/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To compare the prevalence of carotid atherosclerosis in virologically suppressed HIV patients with that of a community sample, and to evaluate the capacity of various cardiovascular risk (CVR) equations for predicting carotid atherosclerosis. METHODS This was a cross-sectional study with two randomly selected groups: HIV patients from an HIV unit and a control group drawn from the community. Participants were matched by age (30-80 years) and sex without history of cardiovascular disease. Carotid plaque, common carotid intima-media thickness (cc-IMT) and subclinical atherosclerosis (carotid plaque and/or cc-IMT > 75th percentile) were assessed by carotid ultrasound. The Systematic Coronary Risk Evaluation (SCORE), Framingham, REGICOR, reduced Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D), and COMVIH equations were applied, and their abilities to predict carotid plaque were compared using the area under the curve (AUC). RESULTS Each group included 379 subjects (77.8% men, age 49.7 years). Duration of antiretroviral therapy was 15.5 years. There were no differences between the groups for carotid plaque (HIV, 33.2%; control, 31.3%), mean cc-IMT (HIV, 0.63 mm; control, 0.61 mm) or subclinical atherosclerosis (HIV, 42.9%; control, 47.9%). Thymidine analogues were independently associated with subclinical atherosclerosis in HIV-infected patients. CVR equations revealed AUCs between 0.715 and 0.807 for prediction of carotid plaque; prediction was better in the control group and did not improve when HIV-adapted scales were used. CONCLUSIONS The features of carotid atherosclerosis did not differ between the HIV-infected and the control group, although CVR equations were more predictive for carotid plaque in controls than in HIV-infected patients. HIV-specific equations did not improve prediction.
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Affiliation(s)
- M Saumoy
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - S Di Yacovo
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - S Pérez
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Cardiovascular Diseases (CIBERCV), Barcelona, Spain
| | - J L Sánchez-Quesada
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - J M Valdivielso
- Biomedical Research Institute of Lleida, IRB, Vascular and Renal Translational Research Group, UDETMA, Lleida, Spain
| | - I Subirana
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - A Imaz
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - J M Tiraboschi
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - B García
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain
| | - J Ordoñez-LLanos
- Biomedical Research Institute IIB Sant Pau, Barcelona, Spain.,Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - S Benítez
- Biochemistry and Molecular Biology Department, Universitat Autònoma, Barcelona, Spain
| | - D Podzamczer
- HIV and STD Unit, Infectious Disease Department, Bellvitge University Hospital, Hospitalet de Llobregat, Spain.,Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat, Spain
| | - M Grau
- Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain.,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Barcelona, Spain.,Department of Medicine, University of Barcelona, Barcelona, Spain
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van Zoest RA, Law M, Sabin CA, Vaartjes I, van der Valk M, Arends JE, Reiss P, Wit FW. Predictive Performance of Cardiovascular Disease Risk Prediction Algorithms in People Living With HIV. J Acquir Immune Defic Syndr 2019; 81:562-71. [PMID: 31045648 DOI: 10.1097/QAI.0000000000002069] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND People living with HIV (PLWH) experience a higher cardiovascular disease (CVD) risk. Yet, traditional algorithms are often used to estimate CVD risk. We evaluated the performance of 4 commonly used algorithms. SETTING The Netherlands. METHODS We used data from 16,070 PLWH aged ≥18 years, who were in care between 2000 and 2016, had no pre-existing CVD, had initiated first combination antiretroviral therapy >1 year ago, and had available data on CD4 count, smoking status, cholesterol, and blood pressure. Predictive performance of 4 algorithms [Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D); Systematic COronary Risk Evaluation adjusted for national data (SCORE-NL); Framingham CVD Risk Score (FRS); and American College of Cardiology and American Heart Association Pooled Cohort Equations (PCE)] was evaluated using a Kaplan-Meier approach. Model discrimination was assessed using Harrell's C-statistic. Calibration was assessed using observed-versus-expected ratios, calibration plots, and Greenwood-Nam-D'Agostino goodness-of-fit tests. RESULTS All algorithms showed acceptable discrimination (Harrell's C-statistic 0.73-0.79). On a population level, D:A:D, SCORE-NL, and PCE slightly underestimated, whereas FRS slightly overestimated CVD risk (observed-versus-expected ratios 1.35, 1.38, 1.14, and 0.92, respectively). D:A:D, FRS, and PCE best fitted our data but still yielded a statistically significant lack of fit (Greenwood-Nam-D'Agostino χ ranged from 24.57 to 34.22, P < 0.05). Underestimation of CVD risk was particularly observed in low-predicted CVD risk groups. CONCLUSIONS All algorithms perform reasonably well in PLWH, with SCORE-NL performing poorest. Prediction algorithms are useful for clinical practice, but clinicians should be aware of their limitations (ie, lack of fit and slight underestimation of CVD risk in low-risk groups).
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Mena A, Clavero E, Díaz-Díaz JL, Castro A. Similar plasma lipidomic profile in people living with HIV treated with a darunavir-based or an integrase inhibitor-based antiretroviral therapy. Sci Rep 2019; 9:17184. [PMID: 31748628 PMCID: PMC6868233 DOI: 10.1038/s41598-019-53761-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/05/2019] [Indexed: 01/12/2023] Open
Abstract
Cardiovascular disease is an important cause of morbidity and mortality in people living with HIV (PLWH), who commonly experience lipid disturbances. The aim of this study was to determine whether the plasma lipidomic profile differs between PLWH receiving a darunavir-based ART and those receiving integrase inhibitor-based ART. This was a cross-sectional study of unselected patients for whom metabolomic analysis was performed using ultra-high-performance liquid chromatography coupled to mass spectrometry. Data for the two subgroups were compared by calculating the log2 of the fold change for each metabolite and then grouping these into the main lipid families. Sixty-two PLWH aged 49.3 ± 8.6 years (82% men) were included: 12 patients (19.4%) had hypertension, 8 (12.9%) had type 2 diabetes, 25 (41.0%) had dyslipidaemia and 9 (14.5%) were taking statins, without significant differences in all these variables between the two groups. Twenty-five (40.3%) received darunavir-based ART and 37 (59.7%) integrase inhibitor-based ART. Although the differences were not statistically significant, patients treated with darunavir-based ART had higher concentrations of total cholesterol (211 mg/dL vs 194 mg/dL), LDL-cholesterol (132 mg/dL vs 117 mg/dL) and triglycerides (155 mg/dL vs 122 mg/dL), and lower HDL-cholesterol concentration (50 mg/dL vs 52 mg/dL). The main lipid families and metabolites differed slightly between groups (log2-fold change; P-value): ceramides (-0.07; 0.49), phosphatidylinositols (-0.05; 0.63), diacylglycerols (0.10; 0.64), phosphatidylethanolamines (0.03; 0.78), triacylglycerols (0.27; 0.18) and lysophosphatidylethanolamines (0.03; 0.83). In the integrase inhibitor-based group, the use of tenofovir alafenamide fumarate significantly increases the majority of lipid fractions, when compared with tenofovir disoproxil fumarate. The lipidomic profile did not differ between PLWH treated with darunavir-based or integrase inhibitor-based ART. This was especially true for ceramides, which are involved in cardiovascular disease. Further studies are needed to study the impact of ART in lipidomic profile.
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Affiliation(s)
- Alvaro Mena
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidad de A Coruña (UDC), A Coruña, Spain. .,Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
| | - Elvira Clavero
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidad de A Coruña (UDC), A Coruña, Spain.,Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - José Luis Díaz-Díaz
- Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Angeles Castro
- Grupo de Virología Clínica, Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidad de A Coruña (UDC), A Coruña, Spain.,Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
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8
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Tziomalos K. Cardiovascular risk prediction in patients with HIV infection. Future Virol 2019. [DOI: 10.2217/fvl-2019-0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Konstantinos Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
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Feinstein MJ, Hsue PY, Benjamin LA, Bloomfield GS, Currier JS, Freiberg MS, Grinspoon SK, Levin J, Longenecker CT, Post WS. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e98-e124. [PMID: 31154814 DOI: 10.1161/cir.0000000000000695] [Citation(s) in RCA: 345] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
As early and effective antiretroviral therapy has become more widespread, HIV has transitioned from a progressive, fatal disease to a chronic, manageable disease marked by elevated risk of chronic comorbid diseases, including cardiovascular diseases (CVDs). Rates of myocardial infarction, heart failure, stroke, and other CVD manifestations, including pulmonary hypertension and sudden cardiac death, are significantly higher for people living with HIV than for uninfected control subjects, even in the setting of HIV viral suppression with effective antiretroviral therapy. These elevated risks generally persist after demographic and clinical risk factors are accounted for and may be partly attributed to chronic inflammation and immune dysregulation. Data on long-term CVD outcomes in HIV are limited by the relatively recent epidemiological transition of HIV to a chronic disease. Therefore, our understanding of CVD pathogenesis, prevention, and treatment in HIV relies on large observational studies, randomized controlled trials of HIV therapies that are underpowered to detect CVD end points, and small interventional studies examining surrogate CVD end points. The purpose of this document is to provide a thorough review of the existing evidence on HIV-associated CVD, in particular atherosclerotic CVD (including myocardial infarction and stroke) and heart failure, as well as pragmatic recommendations on how to approach CVD prevention and treatment in HIV in the absence of large-scale randomized controlled trial data. This statement is intended for clinicians caring for people with HIV, individuals living with HIV, and clinical and translational researchers interested in HIV-associated CVD.
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Abstract
PURPOSE OF REVIEW The objective of this review is to provide an update on the link between HIV infection and cardiovascular disease (CVD). We will focus our review mainly on literature describing clinical CVD events and understudied topics of importance. RECENT FINDINGS Heart failure, peripheral artery disease, and stroke are CVD modalities deserving more attention in the context of HIV infection in the highly active antiretroviral therapy era. Incidence data on clinical CVD from HIV populations in low- and middle-income countries are limited. Multisubstance use is common in HIV, but understudied as a moderator or mediator of the association between HIV and CVD. CVD risk assessment in HIV remains challenging, but new research into novel biomarkers may provide further insights. There is also a need for inclusion of non-biologic factors in our attempts to understand, quantify, and predict CVD risk among PLWHA. Significant attention has been paid to generating and testing hypotheses to understand the mechanisms of myocardial infarction in HIV. Similar attention is deserving for heart failure, PAD, stroke, and cardiovascular disease risk in resource-limited settings and among substance users with HIV.
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Affiliation(s)
- Kaku So-Armah
- School of Medicine, Boston University, Boston, MA, USA.
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Affiliation(s)
- Matthew J Feinstein
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Joseph A Delaney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle
| | - Heidi M Crane
- Division of Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Seattle
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Raggi P, Prandini N, Ligabue G, Braglia G, Esposito F, Milic J, Malagoli A, Scaglioni R, Besutti G, Beghetto B, Nardini G, Roncaglia E, Mussini C, Guaraldi G. Molecular Imaging of Vascular Calcification with 18F-Sodium-Fluoride in Patients Infected with Human Immunodeficiency Virus. Int J Mol Sci 2019; 20:ijms20051183. [PMID: 30857165 PMCID: PMC6429185 DOI: 10.3390/ijms20051183] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
18F-Sodium Fluoride (NaF) accumulates in areas of active hydroxyapatite deposition and potentially unstable atherosclerotic plaques. We assessed the presence of atherosclerotic plaques in 50 adult patients with HIV (HIV+) who had undergone two cardiac computed tomography scans to measure coronary artery calcium (CAC) progression. CAC and its progression are predictive of an unfavorable prognosis. Tracer uptake was quantified in six arterial territories: aortic arch, innominate carotid artery, right and left internal carotid arteries, left coronary (anterior descending and circumflex) and right coronary artery. Thirty-one patients showed CAC progression and 19 did not. At least one territory with high NaF uptake was observed in 150 (50%) of 300 arterial territories. High NaF uptake was detected more often in non-calcified than calcified areas (68% vs. 32%), and in patients without than in those with prior CAC progression (68% vs. 32%). There was no correlation between clinical and demographic variables and NaF uptake. In clinically stable HIV+ patients, half of the arterial territories showed a high NaF uptake, often in the absence of macroscopic calcification. NaF uptake at one time point did not correlate with prior progression of CAC. Prospective studies will demonstrate the prognostic significance of high NaF uptake in HIV+ patients.
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Affiliation(s)
- Paolo Raggi
- Division of Cardiology and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, 11220 83rd Avenue, Suite 5A9-014, Edmonton, AB T6G 2B7, Canada.
| | - Napoleone Prandini
- Department of Nuclear Medicine, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Guido Ligabue
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Braglia
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Francesco Esposito
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Jovana Milic
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Andrea Malagoli
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Riccardo Scaglioni
- Department of Radiology, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Besutti
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Barbara Beghetto
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giulia Nardini
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Enrica Roncaglia
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Cristina Mussini
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
| | - Giovanni Guaraldi
- Modena HIV Metabolic Clinic, Azienda Ospedaliero-Universitaria di Modena; University of Modena and Reggio Emilia, 41124 Modena, Italy.
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Ryan T, Affandi JS, Gahungu N, Dwivedi G. Noninvasive Cardiovascular Imaging: Emergence of a Powerful Tool for Early Identification of Cardiovascular Risk in People Living With HIV. Can J Cardiol 2018; 35:260-269. [PMID: 30825948 DOI: 10.1016/j.cjca.2018.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/06/2018] [Accepted: 11/20/2018] [Indexed: 12/31/2022] Open
Abstract
Antiretroviral therapy (ART) has been pivotal in prolonging the lifespan of people living with HIV (PLWH). However, this also simultaneously increases their risk of cardiovascular disease (CVD) either related to ART, aging, hypertension, immunosenescence, inflammation, immune activation, or other comorbidities. Although the use of risk markers has greatly enhanced the field of cardiovascular (CV) medicine and improved the prognosis and early diagnosis in the general population, this strategy has not been clearly elucidated in PLWH. Developing accurate risk algorithms for PLWH requires an innate understanding of mechanistic factors influencing their risks. Early identification of CV risk will significantly enhance the prospects of PLWH living longer and relatively healthily. Herein, we discuss the use of multimodality noninvasive CV imaging as robust markers for ameliorating CV risk. The ability to prognosticate CV risk and hence prevent CV events in PLWH would represent an important advance in CV medicine, allowing precise detection and early institution of preventative strategies. Using novel CV imaging modalities and strategies would have a positive impact on precision medicine in this patient cohort.
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Affiliation(s)
- Timothy Ryan
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Jacquita S Affandi
- School of Public Health, Curtin University, Bentley, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
| | - Nestor Gahungu
- Royal Perth Hospital, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia; The University of Western Australia, Crawley, Western Australia, Australia.
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Rahman F, Martin SS, Whelton SP, Mody FV, Vaishnav J, McEvoy JW. Inflammation and Cardiovascular Disease Risk: A Case Study of HIV and Inflammatory Joint Disease. Am J Med 2018; 131:442.e1-442.e8. [PMID: 29269230 DOI: 10.1016/j.amjmed.2017.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 11/25/2017] [Accepted: 11/29/2017] [Indexed: 02/07/2023]
Abstract
The epidemiologic data associating infection and inflammation with increased risk of cardiovascular disease is well established. Patients with chronically upregulated inflammatory pathways, such as those with HIV and inflammatory joint diseases, often have a risk of future cardiovascular risk that is similar to or higher than patients with diabetes. Thus, it is of heightened importance for clinicians to consider the cardiovascular risk of patients with these conditions. HIV and inflammatory joint diseases are archetypal examples of how inflammatory disorders contribute to vascular disease and provide illustrative lessons that can be leveraged in the prevention of cardiovascular disease. Managing chronic inflammatory diseases calls for a multifaceted approach to evaluation and treatment of suboptimal lifestyle habits, accurate estimation of cardiovascular disease risk with potential upwards recalibration due to chronic inflammation, and more intensive treatment of risk factors because current tools often underestimate the risk in this population. This approach is further supported by the recently published CANTOS trial demonstrating that reducing inflammation can serve as a therapeutic target among persons with residual inflammatory risk for cardiovascular disease.
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Affiliation(s)
- Faisal Rahman
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seth S Martin
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Seamus P Whelton
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Freny V Mody
- Department of Medicine, Greater Los Angeles Veterans Affairs Medical and Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at University of California, Los Angeles
| | | | - John William McEvoy
- Division of Cardiology, Department of Medicine; Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
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16
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De Socio GV, Pucci G, Baldelli F, Schillaci G. Observed versus predicted cardiovascular events and all-cause death in HIV infection: a longitudinal cohort study. BMC Infect Dis 2017; 17:414. [PMID: 28606059 PMCID: PMC5467261 DOI: 10.1186/s12879-017-2510-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 05/31/2017] [Indexed: 01/01/2023] Open
Abstract
Background The aim of the study was to assess the applicability of an algorithm predicting 10-year cardiovascular disease (CVD) generated in the setting of the Framingham Heart Study to a real-life, contemporary Italian cohort of HIV-positive subjects. Methods The study was an observational longitudinal cohort study. The probability for 10-year CVD events according to the Framingham algorithm was assessed in 369 consecutive HIV-positive participants free from overt CVD enrolled in 2004, who were followed for a median of 10.0 years (interquartile range, 9.1-10.1). Cardiovascular events included myocardial infarction, hospitalized heart failure, revascularized angina, sudden cardiac death, stroke, peripheral arterial disease. Results Over 3097 person-years of observation, we observed a total of 34 CVD events, whereas Framingham algorithm predicted the occurrence of 34.3 CVD events. CVD event rate was 11.0/1000 person-years of follow-up. In a receiver operating characteristics curve analysis, Framingham risk equation showed an excellent predictive value for incident CVD events (c-statistics, 0.83; 95% confidence interval, 0.76-0.90). In a multivariable Cox analysis, age, smoking and diabetes were independent predictors of CVD events. All-cause death rate was 20.0/1000 person-years of follow-up (n = 62 deaths). Causes of death included liver diseases (18), malignancies (14), AIDS-related (11); cardiovascular (9) and others (10). In a Cox analysis, age, AIDS diagnosis and chronic hepatitis were independent predictors of death. Conclusions Observed CVD events in HIV-infected patients were well predicted by Framingham algorithm. Established major CVD risk factors are the strongest determinants of CVD morbidity in an Italian contemporary cohort of HIV-positive subjects. Interventions to modify traditional risk factors are urgently needed in HIV people.
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Affiliation(s)
- Giuseppe Vittorio De Socio
- From the Department of Medicine, Unit of Infectious Diseases Azienda Ospedaliera of Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy.
| | - Giacomo Pucci
- Department of Medicine, University of Perugia and Unit of Internal Medicine, "Santa Maria" Hospital, Terni, Italy
| | - Franco Baldelli
- From the Department of Medicine, Unit of Infectious Diseases Azienda Ospedaliera of Perugia and University of Perugia, Santa Maria Hospital, Perugia, Italy
| | - Giuseppe Schillaci
- Department of Medicine, University of Perugia and Unit of Internal Medicine, "Santa Maria" Hospital, Terni, Italy
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Non LR, Escota GV, Powderly WG. HIV and its relationship to insulin resistance and lipid abnormalities. Transl Res 2017; 183:41-56. [PMID: 28068521 DOI: 10.1016/j.trsl.2016.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022]
Abstract
Antiretroviral therapy has revolutionized the care of people with human immunodeficiency virus (HIV) by reducing morbidity and mortality from acquired immunodeficiency syndrome-related conditions. Despite longer life expectancy, however, HIV-infected individuals continue to have a higher risk of death compared with the general population. This has been attributed to the increasing incidence of noncommunicable diseases, in particular, atherosclerotic cardiovascular diseases. This is driven, in part, by the emergence of metabolic disorders, particularly dyslipidemia, insulin resistance, and lipodystrophy, in those on antiretroviral therapy. The pathogenesis of these metabolic derangements is complex and multifactorial, and could be a consequence of an interplay between traditional age-related risk factors, HIV infection, antiretroviral therapy effects, and the inflammatory state and immune activation in this population. Understanding the contributions of each of these factors could not just impact the current management of these individuals and help mitigate the risk for premature cardiovascular disease, but also shape the future direction of research in HIV.
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Affiliation(s)
- Lemuel R Non
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo.
| | - Gerome V Escota
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - William G Powderly
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
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Mosepele M, Hemphill LC, Palai T, Nkele I, Bennett K, Lockman S, Triant VA. Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa. PLoS One 2017; 12:e0172897. [PMID: 28235058 PMCID: PMC5325544 DOI: 10.1371/journal.pone.0172897] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 02/10/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES HIV-infected patients are at increased risk for cardiovascular disease (CVD). However, general population CVD risk prediction equations that identify HIV-infected patients at elevated risk have not been widely assessed in sub-Saharan African (SSA). METHODS HIV-infected adults from 30-50 years of age with documented viral suppression were enrolled into a cross-sectional study in Gaborone, Botswana. Participants were screened for CVD risk factors. Bilateral carotid intima-media thickness (cIMT) was measured and 10-year predicted risk of cardiovascular disease was calculated using the Pooled Cohorts Equation for atherosclerotic CVD (ASCVD) and the 2008 Framingham Risk Score (FRS) (National Cholesterol Education Program III-NCEP III). ASCVD ≥7.5%, FRS ≥10%, and cIMT≥75th percentile were considered elevated risk for CVD. Agreement in classification of participants as high-risk for CVD by cIMT and FRS or ASCVD risk score was assessed using McNemar`s Test. The optimal cIMT cut off-point that matched ASCVD predicted risk of ≥7.5% was assessed using Youden's J index. RESULTS Among 208 HIV-infected patients (female: 55%, mean age 38 years), 78 (38%) met criteria for ASCVD calculation versus 130 (62%) who did not meet the criteria. ASCVD classified more participants as having elevated CVD risk than FRS (14.1% versus 2.6%, McNemar's exact test p = 0.01), while also classifying similar proportion of participants as having elevated CVD like cIMT (14.1% versus 19.2%, McNemar's exact test p = 0.34). Youden's J calculated the optimal cut point at the 81st percentile for cIMT to correspond to an ASCVD score ≥7.5% (sensitivity = 72.7% and specificity = 88.1% with area under the curve for the receiver operating characteristic [AUC] of 0.82, 95% Mann-Whitney CI: 0.66-0.99). CONCLUSION While the ASCVD risk score classified more patients at elevated CVD risk than FRS, ASCVD score classified similar proportion of patients as high risk when compared with established subclinical atherosclerosis. However, potential CVD risk category misclassification by established equations such as ASCVD may still exist among HIV-infected patients; hence there is still a need for development of a CVD risk prediction equation tailored to HIV-infected patients in SSA.
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Affiliation(s)
- Mosepele Mosepele
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- * E-mail:
| | - Linda C. Hemphill
- The Heart Center, Division of Cardiology, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
| | - Tommy Palai
- Department of Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Isaac Nkele
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Kara Bennett
- Bennett Statistical Consulting Inc, Ballston Lake, New York, United States of America
| | - Shahin Lockman
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Brigham & Women`s Hospital, Boston, Massachusetts, United States of America
- Department of Immunology & Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Virginia A. Triant
- Division of General Internal Medicine & Division of Infectious Diseases, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts, United States of America
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