High correlation between Framingham equations with BMI and with lipids to estimate cardiovascular risks score at baseline in HIV-infected adults in the Temprano trial, ANRS 12136 in Côte d’Ivoire

<div><p>Context</p><p>Data on cardiovascular risk (CVR) score among HIV-infected patients in sub-Saharan Africa are scarce. Our first objective was to compare the CVR score of Framingham utilizing BMI and lipids at baseline, and secondary to assess evolution of CVR score over time at Month 30 in the Temprano trial.</p><p>Methods</p><p>HIV-infected adults with CD4 <800/mm³ without criteria for initiating ART were included and followed for 30 months in the Temprano trial, which assessed the benefits and risks of early antiretroviral treatment (ART) vs deferred ART. CVR score was estimated at baseline and Month-30 using Framingham equations with either BMI or lipids and classified as high (>20%), moderate (10–20%), and low risk (<10%). At baseline, we compare these two estimations utilizing the Pearson correlation test and analyze the increasing CV risk score over time by Proportional odds cumulative logit models for people attending the Month-30 (M30) visit.</p><p>Results</p><p>Among the 2056 patients, 78% were women, median age was 35 years, and median CD4 count was 464/mm³, 6.8% were obese, 6.3% had hypertension, 7.8% were smokers (1.8% women, 26.8% men), 19% had Total Cholesterol (TC) >5mmol/L, and 1% diabetes at baseline. At baseline the concordance between the two Framingham equations was excellent (r = 0.95; p<0.0001). Among the 1700 patients who attended M30 visit and with available data, 1.3% had a high CV risk score at baseline and 3.1% at M30 visit using Framingham equation with BMI. Adjusted odds ratio (aOR) of being at a higher CV risk score at M30 visit compared to a higher CV risk score at M0 visit was 1.35 (CI 95% 1.17–1.57). Stratified by sex, the increasing CV risk score was OR 1.73 (CI 95%: 1.30–2.29) for women and OR 1.24 (CI 95%: 1.02–1.50) for men. Early ART was not associated with an increasing CV risk score (p = 0.88). Results for the 1422 patients with Framingham equation using lipids were similar.</p><p>Conclusion</p><p>In a large trial evaluating early ART for HIV infection in Côte d’Ivoire, Framingham equation with BMI and lipids were highly correlated and CV risk score increases over time. Early ART was not significantly associated with this increasing CV risk score.</p></div

Evolution of the CV risk score with Framingham equation using BMI between M0 and M30.

<p>Proportional odds cumulative logit model, N = 1700.</p

Quantiferon-TB Gold: Performance for Ruling out Active Tuberculosis in HIV-Infected Adults with High CD4 Count in Côte d'Ivoire, West Africa

<div><p>Objective</p><p>To assess the performance of QuantiFERON-TB Gold In-Tube (QFT-GIT) test for active tuberculosis (TB) in HIV adults, and its variation over time in patients on antiretroviral therapy (ART) and/or isoniazide preventive therapy (IPT).</p><p>Methods</p><p>Transversal study and cohort nested in the Temprano ANRS 12136 randomized controlled trial assessing benefits of initiating ART earlier than currently recommended by World Health Organization, with or without a 6-month IPT. Performance of QFT-GIT for detecting active TB at baseline in the first 50% participants, and 12-month incidence of conversion/reversion in the first 25% participants were assessed. QFT-GIT threshold for positivity was 0.35 IU/ml.</p><p>Results</p><p>Among the 975 first participants (median baseline CD4 count 383/mm³, positive QFT-GIT test 35%), 2.7% had active TB at baseline. QFT-GIT sensitivity, specificity, positive and negative predictive value for active TB were 88.0%, 66.6%, 6.5% and 99.5%. For the 444 patients with a second test at 12 months, rates for conversion and reversion were 9.3% and 14%. Reversion was more frequent in patients without ART and younger patients. IPT and early ART were not associated with reversion/conversion.</p><p>Conclusion</p><p>A negative QFT-GIT could rule out active TB in HIV-infected adults not severely immunosuppressed, thus avoiding repeated TB testing and accelerating diagnosis and care for other diseases.</p><p>Trial Registration</p><p>ClinicalTrials.gov <a href="http://clinicaltrials.gov/ct2/results?term=NCT00495651" target="_blank">NCT00495651</a>.</p></div

Evolution of the CV risk score with Framingham equation (with lipids) between M0 and M30.

<p>Proportional odds cumulative logit model, N = 1422^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0177440#t002fn001" target="_blank">*</a>}.</p

Changes in prevalence of different CV risk factors according to sex in patients with available data at M0 and M30, Temprano trial (N = 1724).

<p>* High waist circumference: ≥88 cm in women and ≥102 cm in men. **TC: total cholesterol. *** Low HDL-c: High density lipoprotein cholesterol, <1.2 mmol/l in women and <1 mmol/l in men. ****Smoker is defined as an individual who smokes at least one cigarette per day. BMI: body mass index; HBP: high blood pressure; HDL-c: high density lipoprotein cholesterol; P: p-value of Chi 2 test.</p

Flow chart of the Temprano trial, (N = 2056).

<p>Flow chart of the Temprano trial, (N = 2056).</p

Agreement between the Framingham equations using lipids and BMI; Temprano trial (N = 1422).

<p>Agreement between the Framingham equations using lipids and BMI; Temprano trial (N = 1422).</p

Distribution of QuantiFERON TB Gold in-tube test results at Day-0, by CD4 count category in patients with positive tests and with or without active tuberculosis.

<p>Box plots show median value, interquartile range, and range. <i>p</i>: Kruskal-Wallis test.</p

Flow chart.

<p>POS: Positive QuantiFERON TB Gold in-tube test; NEG: Positive QuantiFERON TB Gold in-tube test; INDET: Indeterminate QuantiFERON TB Gold in-tube test.</p