CVD risk scores for HIV positive individuals

Postgraduate Thesis uoadl:2897362 21 Read counter

Κατεύθυνση Βιοστατιστική
Library of the School of Health Sciences
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Velisaris Georgios
Supervisors info:
Γιώτα Τουλούμη, Καθηγήτρια, Ιατρική, ΕΚΠΑ
Νίκος Πανταζής, ΕΔΙΠ, Ιατρική, ΕΚΠΑ
Χαράλαμπος Βλαχόπουλος , Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Σκορ εκτίμησης καρδιαγγειακού κινδύνου σε HIV οροθετικά άτομα
Translated title:
CVD risk scores for HIV positive individuals
Introduction: Nowadays, due to successful therapeutic strategies in antiretroviral
treatment, HIV-positive individuals no longer die of AIDS but chronic diseases.In
HIV-positive individuals there has been a higher mortality rate for cardiovascular
disease. Various risk factors other than those already known, have been implicated.
The most likely causes are disorders in immunodeficiency and antiretroviral
treatment. The Framingham Risk Score, AHA Risk Score and European SCORE are
models that predict cardiovascular risk, based on known easily measurable risk
factors, and they have been applied to seropositive populations. HIV-positive
individuals have been proposed equations D: A: D (Data Collection on Adverse
Events of Anti-HIV Drugs), which take into account factors associated with HIV
infection such as exposure to specific antiretroviral therapies. Previous studies have
provided contradictory results in comparing their prognostic value in HIV-positive
Method:We therefore compared the predictive value of different scores in HIVinfected
individuals using data from the AMACS (Athens Multicenter AIDS Cohort
Study) multicenter prospective study. To achieve this, we risk stratified each SCORE
and plotted the Kaplan Meier estimate of survival of each risk group. After studying
the ability of scores to distinguish high-risk individuals from low-risk graphics,
we calculated harrel’s C, studied discrimination graphics with ROC curves, and
performed tests of goodness of fit of the classic models and their recalibration. We
also described and plotted the ROC curves' AUCs and c-indexes as a function of
Results: scores gave similar results with harrel’s C: 0.74,0.74,0.71,0.66 for
SCORE FRS, DAD, AHA and European SCORE respectively. The AUCs of the ROC
curves are consistent with Harrel-c. The best fit to the data based on the Hosmer
Lemeshow X2 test was the DAD Score.
Discussion: DAD score has the best predictive value, as it’s the score with the best
combination of calibration and discrimination. The development of new biomarkers,
which can be added to the model, can improve this model. Regarding the
methodology, it is possible that in future, the time changes of the risk factors will be
better managed in statistical analysis.
Main subject category:
Health Sciences
HIV-positive, CVD risk scores, Predictive ability
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