Noncardiac Lebanese hospitalized adult patients’ awareness of their coronary artery disease risk factors

Fatima Ghaddar,1 Pascale Salameh,1–3 Nadine Saleh,1,2 Firas Farhat,4 Ramez Chahine,5 Nathalie Lahoud,1–3,6 Mira Hleyhel,1,2,6 Rouba K Zeidan,1,2,6 1Faculty of Public Health II, Lebanese University, Fanar, Lebanon; 2National Institute of Public Health, Clinical Epidemiology and Toxicology, Faculty of Public Health, Lebanese University, Fanar, Lebanon; 3Laboratory of Epidemiological and Clinical Research, Lebanese University, Beirut, Lebanon; 4Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon; 5Faculty of Public Health, La Sagesse University, Beirut, Lebanon; 6CERIPH, Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon Background: Noncommunicable diseases are the leading cause of death in Lebanon, with cardiovascular diseases accounting for almost half of the annual deaths. Purpose: We aimed to determine awareness of noncardiac Lebanese hospitalized patients for their coronary artery disease risk factors, their level of adherence to medications or lifestyle modifications, and assess factors associated with awareness. Materials and methods: A cross-sectional study was conducted in 14 hospitals with a total of 382 patients. Levels of awareness were evaluated by the comparison of self-report with measurements and laboratory test results. Healthy behaviors and adherence to treatment were evaluated. Factors associated with better awareness were studied using multivariate regressions, while adherence to treatments and healthy lifestyle were described for the different risk factors and in the Framingham Risk Score categories. Results: Our work revealed a moderate-to-high level of awareness (58.7% for overweight/obesity, 75% for hypertension, 85.7% for diabetes, and 86.4% for dyslipidemia) among patients for most cardiovascular risk factors, but a low-to-moderate level of adherence for some interventions such as physical exercise, weight loss, and smoking cessation. Conclusion: The results emphasize on the importance of educational campaigns on healthy habits and screening to improve early diagnosis, increase patients’ awareness of their risk factors, and, therefore, optimize primary prevention. Keywords: coronary artery disease, risk factors, awareness, adherence, cardiovascular risk scor

Invasive cervical cancer in HIV-infected women: risk and survival relative to those of the general population in France. Results from the French Hospital Database on HIV (FHDH)-Agence Nationale de Recherches sur le SIDA et les Hépatites Virales (ANRS) CO4 cohort study.

OBJECTIVES: We examined trends in the incidence rates of invasive cervical cancer (ICC) and in the rate of survival after ICC among women living with HIV (WLHIV) in France and compared them to those of the general population. METHODS: Histologically validated incident cases of ICC in the period 1992-2009 from the French Hospital Database on HIV (FHDH-ANRS CO4) were included in the study. Age-standardized incidence rates were estimated for FHDH and the general population in France for 1992-1996 [pre-combination antiretroviral therapy (cART) period], 1997-2000 (early cART period), 2001-2004 (intermediate cART period), and 2005-2009 (late cART period). Age-standardized incidence ratios (SIRs) were calculated. Five-year survival was compared with that of the general population for ICC diagnosed in 2005-2009 after standardization for age. RESULTS: Among 28 977 WLHIV, 60 incident ICCs were histologically validated. There was a nonsignificant decreasing trend for the incidence across the cART periods (P = 0.07), from 60 to 36/100 000 person-years. The risk of ICC was consistently significantly higher in WLHIV than in the general population; the SIR was 5.4 [95% confidence interval (CI) 3.0-8.9] during the pre-cART period and 3.3 (95% CI 2.2-4.7) in 2005-2009. Survival after ICC did not improve across periods (log-rank P = 0.14), with overall estimated 5-year survival of 78% (95% CI 0.67-0.89%). Five-year survival was similar for WLHIV and the general population for women diagnosed with ICC in 2005-2009, after standardization (P = 0.45). CONCLUSIONS: ICC risk is still more than three times higher in WLHIV than in the general population. Survival after ICC did not improve over time and was similar to that of the general population during the most recent period. Such results call for promotion of the uptake of screening in WLHIV

Risk of AIDS-defining cancers in HIV-1-infected patients (1992–2009): results from FHDH-ANRS CO4

Purpose of the study To describe long-term incidence trends and median age at diagnosis for the three AIDS-defining cancers (ADC) in HIV-1- infected (HIV1+) patients compared to general population. To study the risk of ADC in HIV1+patients with good immune status (CD4≥500/mm3 for at least 2 years). Methods Incident ADC (Kaposi's sarcoma [KS], non-Hodgkin's lymphomas [NHL] and cervix uteri cancer [CUC]) were retrieved in HIV1+adults followed in the French hospital database on HIV (FHDH) cohort between 1992 and 2009. Cancer incidence rates (IR) in general population were calculated using data from the French cancer registries (Francim network). IR among the HIV1+and the general population were standardized using the 5 years age and sex groups structure of the HIV1+population (1997–2009) and standardized incidence ratios (SIR) were estimated in HIV1+ patients vs. general population in 4 calendar periods (1992–1996, 1997–2000, 2001–2004, and 2005–2009). Median age at diagnosis was estimated after adjusting for the difference in age structure between HIV1+and general population. Summary of results 5,935 incident ADC were diagnosed among 100,536 HIV1+ patients followed between 1992 and 2009. All ADC IRs were significantly reduced between pre- and post-cART eras and continue to decline in the cART period (p<10−4). SIR are presented in the table.Median age at diagnosis was significantly younger among HIV1+ patients than the general population for KS (40.4 vs. 42.5; p<10−4), NHL (41.4 vs. 52.5; p<10−4) and CUC (39.3 vs. 42.5; p<10−4). For HIV1+ patients under treatment who maintained controlled viral load (<500 copies/µL) and CD4 ≥500/mm3 for at least 2 years, the risk for KS, NHL and CUC were respectively SIR=71.6 (28.7–147.5), 2.4 (0.9–4.8) and 1.6 (0.3–4.7) vs. general population. Conclusions The incidence rates of KS, NHL and CUC continued to decline through 2009 but the risk remained elevated as compared to general population in the most recent cART period. Despite the great reduction when compared to general population, the risk is still very high for KS in HIV1+patients who maintained CD4 ≥500/mm3 for at least 2 years. The risk was not significant for CUC and NHL