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Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: results from the SIMONE study

De Socio, Giuseppe Vittorio Luigi and Parruti, Giustino and Quirino, Tiziana and Ricci, Elena and Schillaci, Giuseppe and Adriani, Beatrice and Marconi, Patrizia and Franzetti, Marzia and Martinelli, Canio and Vichi, Francesca and Penco, Giovanni and Sfara, Claudio and Madeddu, Giordano and Bonfanti, Paolo (2008) Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: results from the SIMONE study. Journal of Infection, Vol. 57 (1), p. 33-40. ISSN 0163-4453. Article.

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DOI: 10.1016/j.jinf.2008.03.007

Abstract

Objective. To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings.
Design. Multicenter, nationwide cross-sectional study.
Methods. Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms (“PROCAM”, “PROGETTO CUORE”, “SCORE”); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD ≥10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients.
Results. A total of 1230 HIV infected patients (72% males, mean age of 43 ± 9 years), 185 of whom treatment-naïve, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4 ± 7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n = 142) had both a FRS ≥10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p < 0.001).
Conclusions. The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile.

Item Type:Article
ID Code:1836
Status:Published
Refereed:Yes
Uncontrolled Keywords:Antiretroviral therapy, HIV, metabolic syndrome, framingham risk score, cardiovascular disease, lipodystrophy, arteriosclerosis
Subjects:Area 06 - Scienze mediche > MED/10 Malattie dell'apparato respiratorio
Divisions:001 Università di Sassari > 03 Istituti > Malattie infettive e parassitarie
Publisher:Elsevier
ISSN:0163-4453
Copyright Holders:© 2008 The British Infection Society
Deposited On:18 Aug 2009 10:06

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