Cardiovascular risk assessment in persons with HIV infection in the developing world: comparing three risk equations in a cohort of HIV-infected Thais

Abstract

Objective There is growing concern regarding cardiovascular disease in HIV‐infected individuals in developing countries such as Thailand. We evaluated the 10‐year risk of coronary heart disease (CHD) in a Thai HIV‐infected cohort using three cardiovascular risk equations, and assessed the level of agreement among their predictions. Methods We carried out a cross‐sectional analysis of data on 785 Thai subjects followed prospectively in the HIV Netherlands Australia Thailand Collaboration (HIV‐NAT) cohort study from 1996 to 2009. Cardiovascular risk factor history, along with relevant laboratory and clinical data, was collected at follow‐up clinic visits. Ten‐year risks of CHD were calculated using the Framingham, Ramathibodi–Electricity Generating Authority of Thailand (Rama‐EGAT) and Data Collection on Adverse Effects of Anti‐HIV Drugs (D:A:D) risk equations. Results The mean age of the patients was 41.0 years; 55% of the subjects were male. The mean duration of antiretroviral therapy was 7.7 years. The prevalence of cardiovascular risk factors was low, with the most common risk factor being low high‐density lipoprotein (HDL) (36.3%). The prevalence of high cardiovascular risk scores (defined as 10‐year risk of CHD≥10%) was also low: 9.9, 2.1 and 0.8%, by the Framingham, Rama‐EGAT and D:A:D scoring systems, respectively. Only eight subjects (1.0%) had a history of CHD. Bland–Altman plots showed that the Framingham equation predicted a higher risk of CVD compared with the Rama‐EGAT and D:A:D equations, which agreed relatively well. Conclusion The predicted cardiovascular risk in this HIV‐infected Thai cohort was relatively low. The agreement among the Rama‐EGAT and D:A:D risk scores suggests that both equations may be appropriate estimators of cardiovascular risk in this population.

Higher levels of circulating monocyte–platelet aggregates are correlated with viremia and increased sCD163 levels in HIV-1 infection

“…[22][23][24] Increased immune activation of monocytes was reported to be involved in HIV-1 pathogenesis and thus associated with CVD risk. 17,28,29 In the present study, we demonstrated that in contrast to the decreased percentage of CD14 high CD16 2 monocyte subset, CD14 dim CD16 1 and CD14 high CD16 1 monocyte subsets were expanded during both primary and chronic HIV-1 infection.…”

“…18 MPA is regarded as a more sensitive marker of platelet activation than P-selectin (CD62P), a molecule that binds to Pselectin glycoprotein ligand-1 (PSGL-1) on monocytes, and is closely correlated with thromboembolic events. [19][20][21] Cardiovascular risks are increased in HIV-1-infected patients, [22][23][24] and this increase may be due to a mechanism involving monocyte subset distribution, activation, and MPA formation disorders. Increased MPA formation was previously reported in HIV-1-infected patients receiving antiretroviral therapy and in simian immunodeficiency virus infection.…”

Endothelial Dysfunction in HIV

“…A cross-sectional study of HIV-1 infected patients in a Spanish outpatient setting demonstrated that the traditionally used Framingham risk calculation score identified a higher proportion of HIV-1 infected men with a moderate cardiovascular risk compared to other available risk stratification tools (Knobel et al, 2007). However, this tool may not be equally applicable to all populations -for example, in a study which examined the predicted cardiovascular risk in an HIV-1 infected Thai population, the Framingham calculation over estimated the risk of cardiovascular disease compared to other cardiovascular risk equations (Edwards-Jackson et al, 2011). When managing cardiovascular risk in the HIV-1 infected patient, one must advise in the same way as HIV-1 uninfected individuals; for example, addressing lifestyle factors as well as measuring lipid levels, blood pressure and signs of glucose intolerance.…”

Metabolic Syndrome, Diabetes, and Cardiovascular Risk in HIV

“…This finding is contrary to another study from Thailand in which they found that the FRS predicted higher cardiovascular risk than the DAD equation. 70 It is unclear how to interpret these findings because they were studied in diverse HIV populations from Latin America versus Southeast Asia. Additional studies in large cohorts are needed.…”