Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Jan 28;16(1):e0243552.
doi: 10.1371/journal.pone.0243552. eCollection 2021.

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

Frank Mubiru  1 , Barbara Castelnuovo  1 , Steven J Reynolds  2   3 , Agnes Kiragga  1 , Harriet Tibakabikoba  1 , Noela Clara Owarwo  1 , Andrew Kambugu  1 , Mohammed Lamorde  1 , Rosalind Parkes-Ratanshi  1   4
Affiliations
Case Reports

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

Frank Mubiru et al. PLoS One. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

The study was funded in part (SJR) by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health and Janssen pharmaceutical company through Johnson & Johnson corporate citizenship trust. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Classification of ALT cohort participants in CVD risk categories by Framingham (5 year) and full DAD 5-year risk equations.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. WHO. Non---Communicable Disease Risk Factor Baseline Survey UGANDA Geneva; 2016.
    1. Wada N, Jacobson LP, Cohen M, French A, Phair J, Munoz A. Cause-specific life expectancies after 35 years of age for human immunodeficiency syndrome-infected and human immunodeficiency syndrome-negative individuals followed simultaneously in long-term cohort studies, 1984–2008. Am J Epidemiol. 2013;177(2):116–25. 10.1093/aje/kws321 - DOI - PMC - PubMed
    1. Friis-Moller N, Weber R, Reiss P, Thiebaut R, Kirk O, d’Arminio Monforte A, et al. Cardiovascular disease risk factors in HIV patients—association with antiretroviral therapy. Results from the DAD study. AIDS. 2003;17(8):1179–93. 10.1097/01.aids.0000060358.78202.c1 - DOI - PubMed
    1. Dwomoh D, Tambaa C, Ayisi Addo S, Wiah E, Abdulai M, Bosomprah S. Effect of antiretroviral therapy on all-cause mortality among people living with HIV/AIDS in Ghana using Mahalanobis distant metric matching within propensity score caliper analysis: A retrospective cohort study. PLoS One. 2018;13(9):e0203461 10.1371/journal.pone.0203461 - DOI - PMC - PubMed
    1. Kasamba I, Baisley K, Mayanja BN, Maher D, Grosskurth H. The impact of antiretroviral treatment on mortality trends of HIV-positive adults in rural Uganda: a longitudinal population-based study, 1999–2009. Tropical medicine & international health: TM & IH. 2012;17(8):e66–73. 10.1111/j.1365-3156.2012.02841.x - DOI - PMC - PubMed

Publication types