Advances in HIV treatment have dramatically changed the course of HIV disease. The focus of clinical care has shifted from treating opportunistic infections to managing chronic, non-AIDS-related complications. Cardiovascular disease (CVD) has emerged as a major challenge to the long-term health of HIV patients, who face a higher risk than patients without HIV disease because of specific, HIV-related factors which accelerate the development of CVD. The management of CVD and other co-morbidities may differ in the setting of HIV, and significant questions regarding CVD risk prediction and prevention remain unanswered. To provide the best care to HIV populations as they age, there is an urgent need to develop rigorous, evidence-based, HIV- specific CVD risk prediction strategies. Through the proposed study, we will evaluate and develop methods to accurately predict CVD risk in HIV patients, addressing a major knowledge gap in HIV clinical care. These analyses are particularly timely given the paradigm shift occurring in the field of CVD prevention, with the recent development and introduction of a new American College of Cardiology (ACC)/American Heart Association (AHA) risk prediction algorithm which is a key component of newly released cholesterol guidelines. We propose several novel analyses, including 1) the first evaluation of the new ACC/AHA CVD risk prediction algorithm in the setting of HIV; and 2) the first incorporation of HIV itself into CVD risk prediction models. Our study will address the following aims:
Specific Aim 1 : To assess the performance of existing cardiovascular risk prediction algorithms in an HIV clinical care cohort Specific Aim 2: To generate and internally and externally validate new cardiovascular risk prediction algorithms for tailored use in HIV populations To achieve these aims, we will leverage a multidisciplinary team that is comprised of internationally-recognized leaders with the required expertise in relevant fields. Dr. Ralph D?Agostino will serve as Co-Principal Investigator and will apply his decades of experience in risk prediction statistical analysis to lead a team to validate and develop the new risk prediction algorithms. The HIV cohorts which will be used to generate and externally validate the newly-developed HIV-specific risk prediction algorithms are uniquely suited for these analyses and have produced seminal studies in the field of HIV and CVD. Our proposed work aligns with specific research priorities identified in the new 2013 ACC/AHA risk assessment guidelines which include validation of the new CVD risk prediction algorithm in diverse clinical settings. Our findings will have a significant clinical and public health impact, optimizing CVD risk prediction in HIV and informing CVD prevention strategies to improve the long-term health for this population.

Public Health Relevance

Cardiovascular disease (CVD) poses a major long-term health risk for an aging HIV population, yet it is not known how to accurately predict CVD risk HIV patients. This study will assess whether existing CVD risk prediction tools are accurate for HIV patients. Through the study, we will: 1) develop a CVD risk prediction tool tailored to HIV, for the first time directly incorporating HIV as a CVD risk factor into prediction models; and 2) inform public health strategies by providing an evidence-based, clinically applicable tool to identify HIV patients at high CVD risk.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Project (R01)
Project #
5R01HL132786-02
Application #
9395940
Study Section
AIDS Clinical Studies and Epidemiology Study Section (ACE)
Program Officer
Hsu, Lucy L
Project Start
2016-12-15
Project End
2020-11-30
Budget Start
2017-12-01
Budget End
2018-11-30
Support Year
2
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Massachusetts General Hospital
Department
Type
DUNS #
073130411
City
Boston
State
MA
Country
United States
Zip Code
02114
Mosepele, Mosepele; Hemphill, Linda C; Palai, Tommy et al. (2017) Cardiovascular disease risk prediction by the American College of Cardiology (ACC)/American Heart Association (AHA) Atherosclerotic Cardiovascular Disease (ASCVD) risk score among HIV-infected patients in sub-Saharan Africa. PLoS One 12:e0172897
Triant, Virginia A; Grinspoon, Steven K (2017) Epidemiology of ischemic heart disease in HIV. Curr Opin HIV AIDS 12:540-547
Hyle, Emily P; Mayosi, Bongani M; Middelkoop, Keren et al. (2017) The association between HIV and atherosclerotic cardiovascular disease in sub-Saharan Africa: a systematic review. BMC Public Health 17:954
Mosepele, Mosepele; Hemphill, Linda C; Moloi, Walter et al. (2017) Pre-clinical carotid atherosclerosis and sCD163 among virally suppressed HIV patients in Botswana compared with uninfected controls. PLoS One 12:e0179994