XVIII International AIDS Conference


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Framingham cardiovascular risk assessment of HIV/AIDS Brazilian patients on HAART: the importance of looking for additional information

A.B. de Mattos Marinho Sampaio1, P. Feijo Barroso2

1Universidade Federal do Rio de Janeiro, Hospital Escola Sao Francisco de Assis, Infectious Diseases, Rio de Janeiro, Brazil, 2Universidade Federal do Rio de Janeiro, Infectious Diseases, Rio de Janeiro, Brazil

Background: Life style, chronic inflammation, and drug adverse toxicity are suggested mechanisms for cardiovascular diseases associated with HIV infection. The accuracy of the Framingham cardiovascular score (FRS) to predict cardiovascular risk (CVR) among HIV-infected subjects is considered low by several authors. In order to estimate CVR, we evaluated traditional (FRS) and other independent CVR factors in a cohort of HIV-infected Brazilian subjects on antiretroviral therapy (HAART).
Methods: This is a cross-sectional study of 121 subjects on HAART randomly selected from a cohort of 750 subjects in regular care in a outpatient unit in Rio de Janeiro, Brazil. Exposure variables colleted included fasting serum glucose and lipids, urinalysis and renal function markers, blood pressure (BP), electrocardiographic findings, ankle-brachial index (ABI), anthropometric data, tobacco use, family history of cardiovascular diseases (FH), and information on antiretroviral therapy.Metabolic Syndrome (MS) was defined in accordance to IDF (2005). Data analyses included descriptive statistics.
Results: Median age was 43 years and 64% were males. Median time since HIV diagnosis was 107 months and from HAART use was 88 months. 53% were receiving a protease inhibitor and 47% NNRTI. 31% were smokers, 13% had obesity, 12% sedentary lifestyle, 33% dyslipidemia, 16% hyper-LDL, 47% hyper-TG, 34% high TG/low HDL, 7% diabetes, and 27% MS. FH was present in 20%, left ventricular hypertrophy (LVH) in 6%, peripheral arterial disease (PAD) in 3%. Median FRS was 4%. When FRS was categorized into two groups, 84% were classified as low risk and 16% as medium/high risk categories.After allowing for the presence of MS, LVH, FH, and PAD, patients were re-classified as 52% in low risk and 48% as medium/high risk groups.
Conclusions: These results support a role for other CVR factors in the global cardiovascular risk assessment of Brazilian AIDS patients on HAART. The investigation of MS, FH, LVH, and occult atherosclerosis may allow to accomplish better primary prevention strategies.

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