Comparison of Predicted Cardiovascular Risk Profiles by Different CVD Risk-Scoring Algorithms between HIV-1-Infected and Uninfected Adults: A Cross-Sectional Study in Tanzania

Abstract

Titus Msoka,1 Josephine Rogath,1 Gary Van Guilder,2 Gibson Kapanda,1 Yvo Smulders,3 Marceline Tutu van Furth,3 John Bartlett,4 Michiel van Agtmael2 1Kilimanjaro Christian Medical Centre, Moshi, Tanzania; 2High Altitude Exercise Physiology, Western Colorado University, Gunnison, CO, USA; 3VU University Medical Centre, Amsterdam, the Netherlands; 4Duke University Medical Centre, Durham, NC, USACorrespondence: Titus MsokaKilimanjaro Christian Medical Centre, P.O.Box 3010, Moshi, TanzaniaEmail [email protected]: Cardiovascular disease (CVD) risk assessment is a suitable way to differentiate between high-risk individuals requiring intervention and risk modification, and those at low risk. However, concerns have been raised when adopting a CVD-risk prediction algorithm for HIV-infected patients in sub-Saharan Africa.Patients and Methods: We compared cardiovascular risk profiles between HIV-infected (with and without antiretroviral therapy (ART)) and HIV-uninfected adults as predicted by the American College of Cardiology/American Heart Association (ASCVD) and the Framingham cardiovascular risk score (FRS) algorithms and assessed the concordance of the algorithms in predicting 10-year CVD risk separately in HIV-infected and uninfected groups in a hospital-based cross-sectional study in Tanzania. A cross-sectional hospital-based study including 40 HIV-infected ART-naive, 64 HIV-infected on ART, and 50 HIV-uninfected adults was conducted. Traditional cardiovascular risk factors were determined by standard investigations. The primary outcome was the absolute 10-year CVD risk score based on the two algorithms.Results: Compared to HIV-uninfected, HIV-infected adults were classified at a higher 10-year CVD risk. ASCVD algorithms predicted a higher proportion of high-risk individuals compared to FRS in both HIV-infected and uninfected groups. The concordance between ASCVD and FRS-lipid algorithms was reasonable for both HIV-infected and uninfected groups though relatively higher in the HIV-uninfected group.Conclusion: HIV-infected individuals have a higher 10-year cardiovascular risk compared to HIV-uninfected persons. The concordance between ASCVD and FRS-lipid algorithms is reasonable in both HIV-uninfected and infected persons in Tanzania. Development of an HIV-specific algorithm is needed to accurately predict CVD risk in this population at high-risk.Keywords: atherosclerotic cardiovascular disease risk score, Framingham risk score, antiretroviral therapy, Kilimanjaro Christian Medical Center, Moshi

Keywords

• atherosclerotic cardiovascular disease risk score
• framingham risk score
• antiretroviral therapy
• kilimanjaro christian medical center
• moshi