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Roy Cardinal MH, Durand M, Chartrand-Lefebvre C, Soulez G, Tremblay C, Cloutier G. Associative Prediction of Carotid Artery Plaques Based on Ultrasound Strain Imaging and Cardiovascular Risk Factors in People Living With HIV and Age-Matched Control Subjects of the CHACS Cohort. J Acquir Immune Defic Syndr 2022; 91:91-100. [PMID: 35510848 DOI: 10.1097/qai.0000000000003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/26/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a need for a specific atherosclerotic risk assessment for people living with HIV (PLWH). SETTING A machine learning classification model was applied to PLWH and control subjects with low-to-intermediate cardiovascular risks to identify associative predictors of diagnosed carotid artery plaques. Associations with plaques were made using strain elastography in normal sections of the common carotid artery and traditional cardiovascular risk factors. METHODS One hundred two PLWH and 84 control subjects were recruited from the prospective Canadian HIV and Aging Cohort Study (57 ± 8 years; 159 men). Plaque presence was based on clinical ultrasound scans of left and right common carotid arteries and internal carotid arteries. A classification task for identifying subjects with plaque was defined using random forest (RF) and logistic regression models. Areas under the receiver operating characteristic curves (AUC-ROCs) were applied to select 5 among 50 combinations of 4 or less features yielding the highest AUC-ROCs. RESULTS To retrospectively classify individuals with and without plaques, the 5 most discriminant combinations of features had AUC-ROCs between 0.76 and 0.79. AUC-ROCs from RF were statistically significantly higher than those obtained with logistic regressions ( P = 0.0001). The most discriminant features of RF classifications in PLWH were age, smoking status, maximum axial strain and pulse pressure (equal weights), and sex and antiretroviral therapy exposure (equal weights). When considering the whole population, the HIV status was identified as a cofactor associated with carotid artery plaques. CONCLUSIONS Strain elastography adds to traditional cardiovascular risk factors for identifying individuals with carotid artery plaques.
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Affiliation(s)
- Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
| | - Madeleine Durand
- Department of Internal Medicine, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Medicine, University of Montreal, Montréal, Québec, Canada
| | - Carl Chartrand-Lefebvre
- Department of Radiology, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, University of Montreal Hospital, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Cécile Tremblay
- Department of Microbiology and Infectious Diseases, University of Montreal Hospital, Montréal, Québec, Canada; and
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montréal, Québec, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center, Montréal, Québec, Canada
- Department of Radiology, Radio-oncology, and Nuclear Medicine, University of Montreal, Montréal, Québec, Canada
- Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
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Kim TI, Brahmandam A, Sarac TP, Orion KC. Trends and perioperative outcomes of patients with human immunodeficiency virus (HIV) undergoing lower extremity revascularization. Vasc Med 2020; 25:527-533. [PMID: 33019909 DOI: 10.1177/1358863x20952856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The development of highly active antiretroviral therapy (HAART) has significantly improved the life expectancy of patients with human immunodeficiency virus (HIV), but has led to the rise of chronic conditions including peripheral artery disease (PAD). However, trends and outcomes among patients with HIV undergoing lower extremity revascularization are poorly characterized. The aim of this study was to investigate the trends and perioperative outcomes of lower extremity revascularization among patients with HIV and PAD in a national database. The National Inpatient Sample (NIS) was reviewed between 2003 and 2014. All hospital admissions with a diagnosis of PAD undergoing lower extremity revascularization were stratified based on HIV status. Outcomes were assessed using propensity score matching and multivariable regression. Among all patients undergoing lower extremity revascularization for PAD, there was a significant increase in the proportion of patients with HIV from 0.21% in 2003 to 0.52% in 2014 (p < 0.01). Patients with HIV were more likely to be younger, male, and have fewer comorbidities, including coronary artery disease and diabetes, at the time of intervention compared to patients without HIV. With propensity score matching and multivariable regression, HIV status was associated with increased total hospital costs, but not length of stay, major amputation, or mortality. Patients with HIV with PAD who undergo revascularization are younger with fewer comorbidities, but have increased hospital costs compared to those without HIV. Lower extremity revascularization for PAD is safe for patients with HIV without increased risk of in-hospital major amputation or mortality, and continues to increase each year.
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Affiliation(s)
- Tanner I Kim
- Department of Surgery, Division of Vascular Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Anand Brahmandam
- Department of Surgery, Division of Vascular Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Timur P Sarac
- Department of Surgery, Division of Vascular Diseases and Surgery, The Ohio State University School of Medicine, Columbus, OH, USA
| | - Kristine C Orion
- Department of Surgery, Division of Vascular Diseases and Surgery, The Ohio State University School of Medicine, Columbus, OH, USA
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Nguyen I, Kim AS, Chow FC. Prevention of stroke in people living with HIV. Prog Cardiovasc Dis 2020; 63:160-169. [PMID: 32014514 PMCID: PMC7237326 DOI: 10.1016/j.pcad.2020.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
In the era of effective antiretroviral therapy (ART), HIV has become a manageable disease marked by an elevated risk of non-AIDS-related comorbidities, including stroke. Rates of stroke are higher in people living with HIV (PLWH) compared with the general population. Elevated stroke risk may be attributable to traditional risk factors, HIV-associated chronic inflammation and immune dysregulation, and possible adverse effects of long-standing ART use. Tailoring stroke prevention strategies for PLWH requires knowledge of how stroke pathogenesis may differ from non-HIV-associated stroke, knowledge of long-term stroke outcomes in HIV, and accurate stroke risk assessment tools. As a result, the approach to primary and secondary stroke prevention in PLWH relies heavily on guidelines developed for the general population, with an emphasis on optimization of traditional vascular risk factors and early initiation of ART. This review summarizes existing evidence on HIV-associated stroke mechanisms and considerations for stroke prevention for PLWH.
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Affiliation(s)
- Ivy Nguyen
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA, United States of America
| | - Felicia C Chow
- Department of Neurology, University of California, San Francisco, CA, United States of America; Department of Medicine, Division of Infectious Diseases, University of California San Francisco, CA, United States of America.
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Affiliation(s)
- Chris T Longenecker
- 1 Case Western Reserve University School of Medicine, Cleveland, OH, USA.,2 University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH, USA
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