Distribution and Performance of Cardiovascular Risk Scores in a Mixed Population of HIV-Infected and Community-Based HIV-Uninfected Individuals in Uganda

Muiru, Anthony N.; Bibangambah, Prossy; Hemphill, Linda; Sentongo, Ruth; Kim, June-Ho; Triant, Virginia A.; Bangsberg, David R.; Tsai, Alexander C.; Martin, Jeffrey N.; Haberer, Jessica; Boum, Yap; Plutzky, Jorge; Hunt, Peter W.; Okello, Samson; Siedner, Mark J.

doi:10.1097/qai.0000000000001696

Cited by 16 publications

(22 citation statements)

References 49 publications

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“…On the contrary, the prevalence of high SCORE (�5%) or10-year SCORE risk was significantly higher in HIV-infected people. Previous studies have reported contradictory results when comparing FRS risk in HIV-infected and uninfected individuals, with some reporting higher [44], some similar [22,45] and some even lower [46] risk in HIV-infected. It has been shown that the FRS equations underestimate CVD risk in PLHIV [35,47].…”

Section: Hiv-infected Predicted % (95% Ci)mentioning

confidence: 93%

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

Touloumi¹,

Kalpourtzi²,

Papastamopoulos³

et al. 2020

PLoS ONE

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Background Although combined antiretroviral therapy has substantially improved the prognosis of people living with HIV (PLHIV), mortality remains higher compared to the general population, mainly due to higher prevalence of non-HIV-related comorbidities, including cardiovascular diseases (CVD). We assessed the prevalence of CVD risk and its contributing factors in adult PLHIV versus general population controls in Greece.

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Section: Hiv-infected Predicted % (95% Ci)mentioning

confidence: 93%

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

Touloumi¹,

Kalpourtzi²,

Papastamopoulos³

et al. 2020

PLoS ONE

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“…24 Our findings are consistent with previous studies that predicted low mean CVD risk among PLWH in Uganda. 11,12 Only 17% of individuals (26% males and 13% females) in one study had a 10-year CVD risk that exceeded 5%. 12 However, even slightly higher risk of CVD associated with HIV infection is concerning, particularly in older ages, given the increasing longevity of HIV-infected individuals.…”

Section: Journal Of Global Health Reportsmentioning

confidence: 97%

“…Excluding this effect would potentially underestimate CVD risk among HIVinfected individuals as was shown in a Ugandan study that predicted lower CVD risk in PLWH than in matched HIV-uninfected controls. 11 This comparison was based on predictions made with Framingham and American Heart Association's pooled cohort risk scores, neither of which include this direct effect. Other studies have used the Data collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) prediction model which takes into account the effects of low immunity (CD4 cell count) and specific ART drugs on CVD risk.…”

mentioning

confidence: 99%

“…Other studies have used the Data collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) prediction model which takes into account the effects of low immunity (CD4 cell count) and specific ART drugs on CVD risk. 11,12 However, the D:A:D model was also developed for high-income countries and has not been recalibrated for use in sub-Saharan Africa. 13 To fill this gap, we developed a microsimulation model to quantify the proportion of PLWH in Uganda with raised blood pressure and high total cholesterol, and used a risk prediction model calibrated for Uganda that takes into account the direct effect of HIV on CVD, to predict the burden of atherosclerotic CVD (stroke and coronary heart disease) among PLWH.…”

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confidence: 99%

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Quantifying the burden of cardiovascular diseases among people living with HIV in sub-Saharan Africa: findings from a modeling study for Uganda

Kintu

Sando

Guwatudde

et al. 2020

Journal of Global Health Reports

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Background Background The burden of non-communicable diseases (NCDs) is rapidly increasing in low-and middle-income countries, but remains largely unknown among people living with HIV (PLWH) in most sub-Saharan African countries. Methods Methods We estimated the proportion of PLWH in Uganda with raised blood pressure and high total cholesterol, and used a modified cardiovascular disease (CVD) risk prediction model (Globorisk) to assess the 10-year risk of atherosclerotic cardiovascular disease using individual-level data on cardiometabolic risk factors, population-level data on HIV prevalence and ART coverage, and the impact of HIV on blood pressure and cholesterol. Results Results Among PLWH aged 30 to 69 years, the prevalence of raised blood pressure was 30% (95% uncertainty range, UR=27-33%) in women and 26% in men (95% UR=23-29%). The predicted mean 10-year CVD risk was 5% for HIV-infected women, and 6% for HIV-infected men. Five percent (n=41,000) of PLWH may experience a CVD event from 2016 to 2025 with an estimated 38% of these events being fatal. Full ART coverage would have little effect on the predicted number of CVD cases. Conclusions Conclusions Despite having a high prevalence of raised blood pressure, the burden of atherosclerotic CVD among PLWH in Uganda remains low. ART programs should prioritize routine screening and treatment of raised blood pressure. An approach of using HIV treatment delivery platforms to deliver care for NCDs may miss the larger burden of disease among HIV-uninfected individuals that are not routinely seen at health facilities. Increased access to antiretroviral therapy (ART) for people living with HIV (PLWH) has substantially improved survival in countries with a high HIV prevalence. 1 In Uganda, ART coverage reached 70% by 2017 2 while life expectancy at birth increased from 45 years in 2004 (the year ART services were initially rolled out) to 62 years in 2017. 3 In the meantime, there has been an increase in the burden of noncommunicable diseases (NCDs) in most of sub-Saharan Africa. 4 With better survival and subsequent ageing, PLWH are faced with the increasing risk of NCDs, 5,6 predominantly cardiovascular diseases (CVD). 7 This has partly been attributed to inflammatory processes in HIV infection that are associated with an increased risk for CVD. 8 In addition, as a result of increased ART coverage, PLWH increasingly have similar cardiometabolic risk profiles as those of HIV-uninfected individuals. 9 Several studies in high-income countries found a higher CVD risk in PLWH compared with HIV-uninfected individuals. 7 A pooled analysis of these studies estimated a 79% increased risk for myocardial infarction due to HIV infec-Co-senior author Co-senior author a b Kintu A, Sando D, Guwatudde D, et al. Quantifying the burden of cardiovascular diseases among people living with HIV in sub-Saharan Africa: findings from a modeling study for Uganda.

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“…Yet, although risk factors point to increasing risk, little is known about the true prevalence of subclinical vascular disease or clinical ASCVD risk among people living with HIV (PLWH) in SSA 3. Some studies of carotid intima-media thickness4 and various measures of arterial stiffness5–7 have come to mixed conclusions on the relationship between HIV and subclinical vascular disease in varied SSA populations. Yet no prior studies have directly measured the prevalence of subclinical coronary disease among PLWH and controls in SSA using coronary artery calcium (CAC) scores.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery calcium, HIV and inflammation in Uganda compared with the USA

et al. 2019

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ObjectivesTo compare the prevalence of detectable coronary artery calcium (CAC) among higher risk, older people living with HIV (PLWH) and uninfected persons in Uganda versus the USA, and second to explore associations of CAC with HIV-specific variables and biomarkers of inflammation.MethodsThis cross-sectional study of 430 total subjects compared 100 PLWH on antiretroviral therapy and 100 age-matched and sex-matched HIV-uninfected controls in Uganda with 167 PLWH on antiretroviral therapy and 63 uninfected controls in the USA. Multivariable logistic regression was used to examine associations with detectable CAC (CAC >0).ResultsCompared with US subjects, Ugandans were older (mean age 56 vs 52 years) and were more likely to have diabetes (36% vs 3%) and hypertension (85% vs 36%), but were less likely to be male (38% vs 74%) or smokers (4% vs 56%). After adjustment for HIV serostatus, age, sex and traditional risk factors, Ugandans had substantially lower odds of CAC >0 (adjusted OR 0.07 (95% CI 0.03 to 0.17), p<0.001). HIV was not associated with CAC >0 in either country (p>0.1). Among all PLWH, nadir CD4 count was associated with the presence of CAC, and among Ugandans soluble intercellular adhesion molecule (p=0.044), soluble CD163 (p=0.004) and oxidised low-density lipoprotein (p=0.043) were all associated with the presence of CAC.ConclusionsUgandans had a dramatically lower prevalence of any coronary calcification compared with US subjects. The role of HIV infection and inflammation as risk factors for subclinical coronary disease in sub-Saharan Africa merits further investigation.

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Distribution and Performance of Cardiovascular Risk Scores in a Mixed Population of HIV-Infected and Community-Based HIV-Uninfected Individuals in Uganda

Abstract: In this cross-sectional study from Uganda, the FRS-BMI correlated well with standard risk scores and c-IMT. HIV-uninfected individuals had higher risk scores than HIV-infected individuals, and the difference seemed to be driven by modifiable factors.

Cited by 16 publications

References 49 publications

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

Cardiovascular risk factors in HIV infected individuals: Comparison with general adult control population in Greece

Quantifying the burden of cardiovascular diseases among people living with HIV in sub-Saharan Africa: findings from a modeling study for Uganda

Coronary artery calcium, HIV and inflammation in Uganda compared with the USA

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