Elevated cardiac risk score by Atherosclerotic Cardiovascular Disease calculation is associated with albuminuria in older people living with HIV

Abstract Background With a much improved ART of the present day, most morbidities and mortalities in people living with HIV/AIDS (PLWHA) are associated with factors such as non-infectious diseases (NIDs) in the form of coronary heart disease (CHD). This study aimed at determining the prevalence and predictors of coronary heart disease (CHD) using the 10-year atherosclerotic cardiovascular disease (ASCVD) and Framingham risk score (FRS) tools among PLWHA. Methods A hospital-based, observational study was carried out from January 2019 to February 2020 in HIV infected adults. Prevalence of FRS (age 20 to 79) was determined using the National, Heart, Lung and Blood Institute (NHLBI) and prevalence of ASCVD (age 40 to 79) was determined using the peer-reviewed online (ClinCalc.com) tool. Results Using the 10-years ASCVD risk estimation 27.3% of the study participants had an elevated risk > 7.5 % CHD. Similarly using the 10-year FRS, 1.4 % had high-risk score of developing CHD. Using multiple linear regression analysis age (β = .061, p < .001), gender (β = .816, p < .001), systolic blood pressure (β = .21, p < .001), total cholestrol (β = .002, p = .001), high density lipoprotein (β = − .02, p < .001), and Tobacco use (β = .559, p < .001) had significant contribution to the risk of CHD using the ASCVD tool, while using binary logistic regression for the FRS tool, gender (OR = 26.105, 95% C.I. [6.110, 111,543], p < 0.001), age (OR = 1.293, 95% C.I. [1.181, 1.415], P < 0.001), and low HDL-C (OR = 0.887, 95% C.I. [.786, .979], P = 0.19) had significant contribution. Conclusions The prevalence of high-risk CHD among PLWHA using the FRS and ASCVD tools were 1.4 & 27.3 percent respectively. In both the tools advanced age, male gender, and low level HDL were significant contributor for the risk of CHD in PLWHA.

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Mechanisms and primary prevention of atherosclerotic cardiovascular disease among people living with HIV

Current Opinion in HIV and AIDS ◽

10.1097/coh.0000000000000681 ◽

2021 ◽

Vol 16 (3) ◽

pp. 177-185

Author(s):

Matthew S. Durstenfeld ◽

Priscilla Y. Hsue

Keyword(s):

Cardiovascular Disease ◽

Primary Prevention ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Living With Hiv

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Statins for atherosclerotic cardiovascular disease prevention in people living with HIV in Thailand: a cost‐effectiveness analysis

Journal of the International AIDS Society ◽

10.1002/jia2.25494 ◽

2020 ◽

Vol 23 (S1) ◽

Cited By ~ 1

Author(s):

David C Boettiger ◽

Anthony T Newall ◽

Pairoj Chattranukulchai ◽

Romanee Chaiwarith ◽

Suwimon Khusuwan ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cost Effectiveness ◽

Disease Prevention ◽

Cost Effectiveness Analysis ◽

Cardiovascular Disease Prevention ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Effectiveness Analysis ◽

Living With Hiv

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The Andersen–Newman Behavioral Model of Health Service Use as a conceptual basis for understanding patient behavior within the patient–physician dyad: The influence of trust on adherence to statins in older people living with HIV and cardiovascular disease

Cogent Psychology ◽

10.1080/23311908.2015.1038894 ◽

2015 ◽

Vol 2 (1) ◽

pp. 1038894 ◽

Cited By ~ 6

Author(s):

Kimberly Petrovic ◽

Thomas O. Blank

Keyword(s):

Cardiovascular Disease ◽

Health Service ◽

Older People ◽

Service Use ◽

Behavioral Model ◽

Health Service Use ◽

People Living With Hiv ◽

Conceptual Basis ◽

Patient Behavior ◽

Living With Hiv

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347. Hepatic Steatosis in People Living with HIV: Effect of Sex and Race/Ethnicity

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.420 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S184-S184

Author(s):

Roger Bedimo ◽

Jason Gillman ◽

Colby Ayers ◽

Deanna Jody Rogers ◽

Lauren Rogers ◽

...

Keyword(s):

Hepatic Steatosis ◽

Risk Score ◽

Transient Elastography ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Linear Regression Models ◽

Significant Difference ◽

Ascvd Risk ◽

Race Ethnicity ◽

Living With Hiv

Abstract Background Recent studies have shown increased weight gain and visceral adiposity in people living with HIV (PLWH) treated with integrase strand transfer inhibitors (INSTI), mostly among women, Blacks and Hispanics. A potential association of INSTI with hepatic steatosis (HS)—which has been associated with increased atherosclerotic cardiovascular disease (ASCVD) risk in the general population—has never been evaluated. We sought to evaluate the prevalence of HS among PLWH on ART, its association with race/ethnicity and INSTI exposure and its association with ASCVD risk. Methods All patients on stable ART in a large urban clinic were included in the analysis. We calculated Hepatic Steatosis Index (HSI = 8 × (ALT/AST ratio)+BMI (+2, if female; +2, if diabetes mellitus) in all patients and Controlled Attenuation Parameter (CAP) score in a subset that underwent transient elastography. The effects of ART class, race and ethnicity on HSI and CAP were examined using linear regression models adjusting for age. We also correlated HSI with CAP and with ASCVD risk score. Results Among the 3122 patients analyzed, 84.6% were male, 45.1% Black (B), 22.5% Hispanic (H), and 30.0% non-Hispanic Whites (NHW). Mean age was 42 years. ART regimens were INSTI-based (n = 1777), PI (n = 723) or NNRTI (n = 302). A subset of 77 patients underwent transient elastography. There was no significant difference in mean BMI between INSTI (27.87), PI (27.70) and NNRTI (28.26) recipients (P = 0.49). However, HSI was lower for PI (35.99) than for INSTI (36.73) and NNRTI (37.46) groups (P = 0.02). Age is also significantly associated with his (P < 0.01). Mean HSI was higher for H (37.54) than non-Hispanics (36.56 for B and 36.19 for NHW); P = 0.001. HSI was highly correlated with ASCVD risk score (R=0.1; P < 0.001). There was also a strong correlation between HSI and CAP (R=0.45; P < 0.001), and a trend toward high CAP for H vs. B and W (P = 0.11). Conclusion HSI increased with age and was significantly associated with ASCVD risk score, suggesting that HS in PLWH might predict higher ASCVD risk. Hispanics had higher HSI and higher CAP than Blacks and Whites. We did not observe an increased BMI or HS with INSTI exposure in this cohort. PI use was associated with lower risk of HS. Disclosures All authors: No reported disclosures.

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Assessment of atherosclerotic cardiovascular disease risks between people living with HIV receiving first-line and second-line antiretroviral therapy in a resource-limited setting

International Journal of STD & AIDS ◽

10.1177/0956462420972855 ◽

2021 ◽

Vol 32 (5) ◽

pp. 421-426

Author(s):

Jaruwan Tiarukkitsagul ◽

Somnuek Sungkanuparph

Keyword(s):

Cardiovascular Disease ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Second Line ◽

First Line ◽

Resource Limited ◽

Ascvd Risk ◽

The Mean ◽

Living With Hiv ◽

Limited Setting

Cardiovascular disease has become an important health problem in people living with HIV (PLHIV) who receive antiretroviral therapy (ART). Atherosclerotic cardiovascular disease (ASCVD) risk score is a non-invasive tool to estimate the 10-year risk for ASCVD. A cross-sectional study was conducted among PLHIV receiving ART in a resource-limited setting, in order to assess the 10-year ASCVD risk between PLHIV receiving first-line and second-line ART. Of 460 participants with a mean age of 51.2 years, 262 (57.0%) were men. The mean duration of HIV infection was 14.7 years and the mean CD4 cell count was 509 cells/μL. Of all, 345 participants were receiving first-line ART and 115 were receiving second-line ART. The median 10-year ASCVD risk was 3.0% and 5.1% in the first-line and second-line ART groups, respectively ( p = 0.029). The prevalence of a high 10-year ASCVD risk (≥20%) was significantly higher in the second-line ART group (3.5% vs 0.9%, p = 0.048). In multivariate analysis, receiving second-line ART was significantly associated with intermediate to high 10-year ASCVD risk (OR = 2.952; 95% CI, 1.656–6.997; p = 0.015). Atherosclerotic cardiovascular disease risk should be assessed in PLHIV, particularly those who receive second-line ART.

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Comparison of different cardiovascular risk tools used in HIV patient cohorts in sub-Saharan Africa; do we need to include laboratory tests?

PLoS ONE ◽

10.1371/journal.pone.0243552 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0243552

Author(s):

Frank Mubiru ◽

Barbara Castelnuovo ◽

Steven J. Reynolds ◽

Agnes Kiragga ◽

Harriet Tibakabikoba ◽

...

Keyword(s):

Cardiovascular Disease ◽

Risk Score ◽

Assessment Tools ◽

Screening Tools ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

Sub Saharan

Introduction Cardiovascular disease (CVD) is the leading cause of death globally, representing 31% of all global deaths. HIV and long term anti-retroviral therapy (ART) are risk factors for development of CVD in populations of people living with HIV (PLHIV). CVD risk assessment tools are currently being applied to SSA populations, but there are questions about accuracy as well as implementation challenges of these tools in lower resource setting populations. We aimed to assess the level of agreement between the various cardiovascular screening tools (Data collection on Adverse effects of anti-HIV Drugs (D:A:D), Framingham risk score, WHO risk score and The Atherosclerotic Cardiovascular Disease Score) when applied to an HIV ART experienced population in Sub-Saharan Africa. Methods This study was undertaken in an Anti-Retroviral Long Term (ALT) Cohort of 1000 PLHIV in care who have been on ART for at least 10 years in urban Uganda. A systematic review was undertaken to find the most frequently used screening tools from SSA PLHIV populations; these were applied to the ALT cohort. Levels of agreement between the resulting scores (those including lipids and non-lipids based, as well as HIV-specific and non-HIV specific) as applied to our cohort were compared. Prevalence Bias Adjusted Kappa was used to evaluate agreement between tools. Results Overall, PLHIV in ALT cohort had a median score of 1.1–1.4% risk of a CVD event over 5 years and 1.7–2.5% risk of a CVD event over 10 years. There was no statistical difference in the risk scores obtained for this population when comparing the different tools, including comparisons of those with lipids and non-lipids, and HIV specific vs non-HIV specific. Conclusion The various tools yielded similar results, but those not including lipids are more feasible to apply in our setting. Long-term cohorts of PLHIV in SSA should in future provide longitudinal data to evaluate existing CVD risk prediction tools for these populations. Inclusion of HIV and ART history factors to existing scoring systems may improve accuracy without adding the expense and technical difficulty of lipid testing.

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