Dataset Information

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men.

ABSTRACT:

Objective

To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men.

Methods

The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, FRS-S were calculated 10 years before the stroke event and assessed according to HIV status.

Results

A total of 114 stroke events occurred, including 57 HIV+ and 37 HIV- participants with first-ever strokes and 19 fatal strokes. The incidence of first-ever stroke was 1.7/1,000 person-years among HIV- and 3.3/1,000 person-years among HIV+ participants. Among those with strokes, HIV+ participants were younger than HIV- participants (median age 51.3 vs 61.8 years, p < 0.0001). For these men with stroke, the average 10-year risk of stroke was higher for HIV- MSM (6.6% [range 3%-26%] vs 4.9% for HIV+ MSM [range 0%-15%], p < 0.04). Traditional risk factors for stroke were similar among the Framingham cohort and the MACS HIV+ and HIV- participants.

Conclusions

FRS-S prediction was systematically different in HIV+ vs HIV- men with stroke events. The FRS-S underestimates the long-term risk of stroke in HIV+ men.

SUBMITTER: Mateen FJ

PROVIDER: S-EPMC3863354 | biostudies-literature | 2013 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men.

Mateen Farrah J FJ Post Wendy S WS Sacktor Ned N Abraham Alison G AG Becker James T JT Smith Bryan R BR Detels Roger R Martin Eileen E Phair John P JP Shinohara Russell T RT

Neurology 20131108 24

<h4>Objective</h4>To test the predictive accuracy of the Framingham Risk Score for Stroke (FRS-S) in HIV-infected (HIV+) vs HIV-uninfected (HIV-) men.<h4>Methods</h4>The Multicenter AIDS Cohort Study (MACS) is an ongoing prospective study of HIV+ and HIV- men who have sex with men (MSM) enrolled in 4 US cities. We ascertained all reported stroke events during a recent 15-year timeframe (July 1, 1996 to June 30, 2011) among 3,945 participants (1,776 HIV+ and 2,169 HIV-). For those with strokes, F ...[more]

PMID: 24212385

Similar Datasets

Project description:Duration and functional aspects of the oral and systemic antibody responses following HPV vaccination in HIV-negative (HIV-) and HIV-positive (HIV+) men are not well characterized. Oral and systemic HPV-16 and HPV-18-specific antibody levels were evaluated over 18-months of follow-up, in HIV+ and HIV- men. Sera and oral gargles from 147 HIV- men, ages 27-45 and 75 HIV+ men, ages 22-61, who received 3-doses of quadrivalent HPV vaccine were tested for HPV-16 and HPV-18 antibodies at Day 1, Month 7 (1 month post-dose 3), and Month 18 (12 months post-dose 3) and HPV avidity (Day 1, and Month 7) using L1-VLP ELISA. All individuals seroconverted, regardless of HIV-status, following 3-doses of vaccine for HPV-16 and HPV-18. Serum HPV-16 and HPV-18 antibody geometric mean levels were >2-fold lower in HIV+ compared to HIV- men at Month 7 (HPV-16: 808.5 versus 2119.8 EU/mL, and HPV-18: 285.8 versus 611.6 EU/mL, p < 0.001) but not significantly different at Month 18 (HPV-16: 281.8 versus 359.7 EU/mL, p = 0.145, and HPV-18: 120.2 versus 93.4 EU/mL, p = 0.372). Post-vaccination, only oral HPV-16 antibody levels at Month 7 were significantly different between HIV+ and HIV- men (127.7 versus 177.1 EU/mg of IgG, p = 0.008). Among baseline HPV-seronegative men, circulating levels of HPV-16 and HPV-18 antibodies were up to >3 fold lower in HIV+ men, at Months 7 and 18. In contrast, levels of HPV-16 and HPV-18 antibodies after vaccination were not inferior in baseline HPV-seropositive, HIV+ men. HPV-16 and HPV-18 avidity was lower among HIV+ compared to HIV- men at Month 7 (HPV-16: 1.95 M versus 2.12 M, p = 0.027; HPV-18: 1.50 M versus 1.72 M, p < 0.001). Although differences in peak antibody levels were observed between HIV+ and HIV- men following 3 doses of vaccine, plateau antibody levels were overall comparable, and avidity was relatively high for both groups. These data indicate that the vaccine induced antibody affinity maturation in both HIV+ and HIV- men and will likely result in long-term protective immune responses.

Project description:To evaluate the positive predictive values (PPVs) of Breast Imaging and Reporting Data Systems (BI-RADS) assessment categories for breast magnetic resonance (MR) imaging and to identify the BI-RADS MR imaging lesion features most predictive of cancer.This institutional review board-approved HIPAA-compliant prospective multicenter study was performed with written informed consent. Breast MR imaging studies of the contralateral breast in women with a recent diagnosis of breast cancer were prospectively evaluated. Contralateral breast MR imaging BI-RADS assessment categories, morphologic descriptors for foci, masses, non-masslike enhancement (NMLE), and kinetic features were assessed for predictive values for malignancy. PPV of each imaging characteristic of interest was estimated, and logistic regression analysis was used to examine the predictive ability of combinations of characteristics.Of 969 participants, 71.3% had a BI-RADS category 1 or 2 assessment; 10.9%, a BI-RADS category 3 assessment; 10.0%, a BI-RADS category 4 or 5 assessment; and 7.7%, a BI-RADS category 0 assessment on the basis of initial MR images. Thirty-one cancers were detected with MR imaging. Overall PPV for BI-RADS category 4 and 5 lesions was 0.278, with 17 cancers in patients with a BI-RADS category 4 lesion (PPV, 0.205) and 10 cancers in patients with a BI-RADS category 5 lesion (PPV, 0.714). Of the cancers, one was a focus, 17 were masses, and 13 were NMLEs. For masses, irregular shape, irregular margins, spiculated margins, and marked internal enhancement were most predictive of malignancy. For NMLEs, ductal, clumped, and reticular or dendritic enhancement were the features most frequently seen with malignancy. Kinetic enhancement features were less predictive of malignancy than were morphologic features.Standardized terminology of the BI-RADS lexicon enables quantification of the likelihood of malignancy for MR imaging-detected lesions through careful evaluation of lesion features. In particular, BI-RADS assessment categories and morphologic descriptors for masses and NMLE were useful in estimating the probability of cancer.

Project description:BACKGROUND AND PURPOSE:Limited data exist on the performance of the revised Framingham Stroke Risk Score (R-FSRS) and the R-FSRS in conjunction with nontraditional risk markers. We compared the R-FSRS, original FSRS, and the Pooled Cohort Equation for stroke prediction and assessed the improvement in discrimination by nontraditional risk markers. METHODS:Six thousand seven hundred twelve of 6814 participants of the MESA (Multi-Ethnic Study of Atherosclerosis) were included. Cox proportional hazard, area under the curve, net reclassification improvement, and integrated discrimination increment analysis were used to assess and compare each stroke prediction risk score. Stroke was defined as fatal/nonfatal strokes (hemorrhagic or ischemic). RESULTS:After mean follow-up of 10.7 years, 231 of 6712 (3.4%) strokes were adjudicated (2.7% ischemic strokes). Mean stroke risks using the R-FSRS, original FSRS, and Pooled Cohort Equation were 4.7%, 5.9%, and 13.5%. The R-FSRS had the best calibration (Hosmer-Lemeshow goodness-of-fit, ?2=6.55; P=0.59). All risk scores were predictive of incident stroke. C statistics of R-FSRS (0.716) was similar to Pooled Cohort Equation (0.716), but significantly higher than the original FSRS (0.653; P=0.01 for comparison with R-FSRS). Adding nontraditional risk markers individually to the R-FSRS did not improve discrimination of the R-FSRS in the area under the curve analysis, but did improve category-less net reclassification improvement and integrated discrimination increment for incident stroke. The addition of coronary artery calcium to R-FSRS produced the highest category-less net reclassification improvement (0.36) and integrated discrimination increment (0.0027). Similar results were obtained when ischemic strokes were used as the outcome. CONCLUSIONS:The R-FSRS downgraded stroke risk but had better calibration and discriminative ability for incident stroke compared with the original FSRS. Nontraditional risk markers modestly improved the discriminative ability of the R-FSRS, with coronary artery calcium performing the best.

Dataset Information

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men.

Objective

Methods

Results

Conclusions

Publications

Long-term predictive value of the Framingham Risk Score for Stroke in HIV-positive vs HIV-negative men.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets