AustralieFrV1, Main, Exploration, bibRecord, 001047

Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study

Identifieur interne : 001047 ( Main/Exploration ); précédent : 001046; suivant : 001048

Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study

Auteurs : Mark A. Boyd [Australie] ; Amanda Mocroft [Royaume-Uni] ; Lene Ryom [Danemark] ; Antonella D Rminio Monforte [Italie] ; Caroline Sabin [Royaume-Uni] ; Wafaa M. El-Sadr [États-Unis] ; Camilla Ingrid Hatleberg [Danemark] ; Stephane De Wit [Belgique] ; Rainer Weber [Suisse] ; Eric Fontas [France] ; Andrew Phillips [Royaume-Uni] ; Fabrice Bonnet [France] ; Peter Reiss [Pays-Bas] ; Jens Lundgren [Danemark] ; Matthew Law [Australie]

Source :

PLoS Medicine [ 1549-1277 ] ; 2017.

RBID : PMC:5675358

Descripteurs français

KwdFr :
- Adulte, Adulte d'âge moyen, Facteurs de risque, Femelle, Humains, Insuffisance rénale chronique (étiologie), Maladies cardiovasculaires (étiologie), Mâle, Séropositivité VIH (), Taux de filtration glomérulaire, Valeur prédictive des tests, Études prospectives.
MESH :
- étiologie : Insuffisance rénale chronique, Maladies cardiovasculaires.
- Adulte, Adulte d'âge moyen, Facteurs de risque, Femelle, Humains, Mâle, Séropositivité VIH, Taux de filtration glomérulaire, Valeur prédictive des tests, Études prospectives.

English descriptors

KwdEn :
- Adult, Cardiovascular Diseases (etiology), Female, Glomerular Filtration Rate, HIV Seropositivity (complications), Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Renal Insufficiency, Chronic (etiology), Risk Factors.
MESH :
- complications : HIV Seropositivity.
- etiology : Cardiovascular Diseases, Renal Insufficiency, Chronic.
- Adult, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors.

Abstract

Background

The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m²) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events.

Methods and findings

We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m², and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m² thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints.

Conclusions

We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5675358

DOI: 10.1371/journal.pmed.1002424
PubMed: 29112958
PubMed Central: 5675358

Affiliations:

Le document en format XML

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<author><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name>
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<author><name sortKey="Hatleberg, Camilla Ingrid" sort="Hatleberg, Camilla Ingrid" uniqKey="Hatleberg C" first="Camilla Ingrid" last="Hatleberg">Camilla Ingrid Hatleberg</name>
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</affiliation>
</author>
<author><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name>
<affiliation wicri:level="3"><nlm:aff id="aff007"><addr-line>Division of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium</addr-line>
</nlm:aff>
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Division of Infectious Diseases, Saint-Pierre University Hospital, Université Libre de Bruxelles, Brussels</wicri:regionArea>
<placeName><settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Weber, Rainer" sort="Weber, Rainer" uniqKey="Weber R" first="Rainer" last="Weber">Rainer Weber</name>
<affiliation wicri:level="1"><nlm:aff id="aff008"><addr-line>Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland</addr-line>
</nlm:aff>
<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich</wicri:regionArea>
<wicri:noRegion>Zurich</wicri:noRegion>
</affiliation>
</author>
<author><name sortKey="Fontas, Eric" sort="Fontas, Eric" uniqKey="Fontas E" first="Eric" last="Fontas">Eric Fontas</name>
<affiliation wicri:level="3"><nlm:aff id="aff009"><addr-line>Department of Public Health, Nice University Hospital, Nice, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Department of Public Health, Nice University Hospital, Nice</wicri:regionArea>
<placeName><region type="region">Provence-Alpes-Côte d'Azur</region>
<region type="old region">Provence-Alpes-Côte d'Azur</region>
<settlement type="city">Nice</settlement>
</placeName>
</affiliation>
</author>
<author><name sortKey="Phillips, Andrew" sort="Phillips, Andrew" uniqKey="Phillips A" first="Andrew" last="Phillips">Andrew Phillips</name>
<affiliation wicri:level="4"><nlm:aff id="aff003"><addr-line>Department of Infection and Population Health, University College London, London, United Kingdom</addr-line>
</nlm:aff>
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Infection and Population Health, University College London, London</wicri:regionArea>
<placeName><settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
<settlement type="city">Londres</settlement>
</placeName>
<orgName type="university">University College de Londres</orgName>
</affiliation>
</author>
<author><name sortKey="Bonnet, Fabrice" sort="Bonnet, Fabrice" uniqKey="Bonnet F" first="Fabrice" last="Bonnet">Fabrice Bonnet</name>
<affiliation wicri:level="3"><nlm:aff id="aff010"><addr-line>Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux</wicri:regionArea>
<placeName><region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Aquitaine</region>
<settlement type="city">Bordeaux</settlement>
</placeName>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff011"><addr-line>Bordeaux Population Health, INSERM U1219, Université de Bordeaux, Bordeaux, France</addr-line>
</nlm:aff>
<country xml:lang="fr">France</country>
<wicri:regionArea>Bordeaux Population Health, INSERM U1219, Université de Bordeaux, Bordeaux</wicri:regionArea>
<placeName><region type="region">Nouvelle-Aquitaine</region>
<region type="old region">Aquitaine</region>
<settlement type="city">Bordeaux</settlement>
<settlement type="city">Bordeaux</settlement>
</placeName>
<orgName type="university">Université de Bordeaux</orgName>
</affiliation>
</author>
<author><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name>
<affiliation wicri:level="4"><nlm:aff id="aff012"><addr-line>Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
<settlement type="city">Amsterdam</settlement>
</placeName>
<orgName type="university">Université d'Amsterdam</orgName>
</affiliation>
<affiliation wicri:level="4"><nlm:aff id="aff013"><addr-line>Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
<settlement type="city">Amsterdam</settlement>
</placeName>
<orgName type="university">Université d'Amsterdam</orgName>
</affiliation>
<affiliation wicri:level="3"><nlm:aff id="aff014"><addr-line>HIV Monitoring Foundation, Amsterdam, The Netherlands</addr-line>
</nlm:aff>
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>HIV Monitoring Foundation, Amsterdam</wicri:regionArea>
<placeName><settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Lundgren, Jens" sort="Lundgren, Jens" uniqKey="Lundgren J" first="Jens" last="Lundgren">Jens Lundgren</name>
<affiliation wicri:level="3"><nlm:aff id="aff004"><addr-line>Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark</addr-line>
</nlm:aff>
<country xml:lang="fr">Danemark</country>
<wicri:regionArea>Centre of Excellence for Health, Immunity and Infections, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen</wicri:regionArea>
<placeName><settlement type="city">Copenhague</settlement>
<region type="région" nuts="2">Hovedstaden</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Law, Matthew" sort="Law, Matthew" uniqKey="Law M" first="Matthew" last="Law">Matthew Law</name>
<affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Kirby Institute, University of New South Wales, Sydney, Australia</addr-line>
</nlm:aff>
<country xml:lang="fr">Australie</country>
<wicri:regionArea>Kirby Institute, University of New South Wales, Sydney</wicri:regionArea>
<placeName><settlement type="city">Sydney</settlement>
<region type="état">Nouvelle-Galles du Sud</region>
</placeName>
</affiliation>
</author>
</analytic>
<series><title level="j">PLoS Medicine</title>
<idno type="ISSN">1549-1277</idno>
<idno type="eISSN">1549-1676</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
</fileDesc>
<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Cardiovascular Diseases (etiology)</term>
<term>Female</term>
<term>Glomerular Filtration Rate</term>
<term>HIV Seropositivity (complications)</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Predictive Value of Tests</term>
<term>Prospective Studies</term>
<term>Renal Insufficiency, Chronic (etiology)</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Insuffisance rénale chronique (étiologie)</term>
<term>Maladies cardiovasculaires (étiologie)</term>
<term>Mâle</term>
<term>Séropositivité VIH ()</term>
<term>Taux de filtration glomérulaire</term>
<term>Valeur prédictive des tests</term>
<term>Études prospectives</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>HIV Seropositivity</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Cardiovascular Diseases</term>
<term>Renal Insufficiency, Chronic</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Insuffisance rénale chronique</term>
<term>Maladies cardiovasculaires</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Female</term>
<term>Glomerular Filtration Rate</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Predictive Value of Tests</term>
<term>Prospective Studies</term>
<term>Risk Factors</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Facteurs de risque</term>
<term>Femelle</term>
<term>Humains</term>
<term>Mâle</term>
<term>Séropositivité VIH</term>
<term>Taux de filtration glomérulaire</term>
<term>Valeur prédictive des tests</term>
<term>Études prospectives</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title>
<p>The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m<sup>2</sup>
) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events.</p>
</sec>
<sec id="sec002"><title>Methods and findings</title>
<p>We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m<sup>2</sup>
, and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m<sup>2</sup>
 thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, <italic>p <</italic>
 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, <italic>p</italic>
 = 0.005) increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (<italic>p</italic>
 = 0.329 and <italic>p</italic>
 = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints.</p>
</sec>
<sec id="sec003"><title>Conclusions</title>
<p>We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.</p>
</sec>
</div>
</front>
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</div1>
</back>
</TEI>
<affiliations><list><country><li>Australie</li>
<li>Belgique</li>
<li>Danemark</li>
<li>France</li>
<li>Italie</li>
<li>Pays-Bas</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>États-Unis</li>
</country>
<region><li>Angleterre</li>
<li>Aquitaine</li>
<li>Grand Londres</li>
<li>Hollande-Septentrionale</li>
<li>Hovedstaden</li>
<li>Lombardie</li>
<li>Nouvelle-Aquitaine</li>
<li>Nouvelle-Galles du Sud</li>
<li>Provence-Alpes-Côte d'Azur</li>
<li>Région de Bruxelles-Capitale</li>
<li>État de New York</li>
</region>
<settlement><li>Amsterdam</li>
<li>Bordeaux</li>
<li>Bruxelles</li>
<li>Copenhague</li>
<li>Londres</li>
<li>Milan</li>
<li>Nice</li>
<li>Sydney</li>
</settlement>
<orgName><li>University College de Londres</li>
<li>Université d'Amsterdam</li>
<li>Université de Bordeaux</li>
</orgName>
</list>
<tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Boyd, Mark A" sort="Boyd, Mark A" uniqKey="Boyd M" first="Mark A." last="Boyd">Mark A. Boyd</name>
</region>
<name sortKey="Boyd, Mark A" sort="Boyd, Mark A" uniqKey="Boyd M" first="Mark A." last="Boyd">Mark A. Boyd</name>
<name sortKey="Law, Matthew" sort="Law, Matthew" uniqKey="Law M" first="Matthew" last="Law">Matthew Law</name>
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<country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Mocroft, Amanda" sort="Mocroft, Amanda" uniqKey="Mocroft A" first="Amanda" last="Mocroft">Amanda Mocroft</name>
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<name sortKey="Phillips, Andrew" sort="Phillips, Andrew" uniqKey="Phillips A" first="Andrew" last="Phillips">Andrew Phillips</name>
<name sortKey="Sabin, Caroline" sort="Sabin, Caroline" uniqKey="Sabin C" first="Caroline" last="Sabin">Caroline Sabin</name>
</country>
<country name="Danemark"><region name="Hovedstaden"><name sortKey="Ryom, Lene" sort="Ryom, Lene" uniqKey="Ryom L" first="Lene" last="Ryom">Lene Ryom</name>
</region>
<name sortKey="Hatleberg, Camilla Ingrid" sort="Hatleberg, Camilla Ingrid" uniqKey="Hatleberg C" first="Camilla Ingrid" last="Hatleberg">Camilla Ingrid Hatleberg</name>
<name sortKey="Lundgren, Jens" sort="Lundgren, Jens" uniqKey="Lundgren J" first="Jens" last="Lundgren">Jens Lundgren</name>
</country>
<country name="Italie"><region name="Lombardie"><name sortKey="Monforte, Antonella D Rminio" sort="Monforte, Antonella D Rminio" uniqKey="Monforte A" first="Antonella D Rminio" last="Monforte">Antonella D Rminio Monforte</name>
</region>
</country>
<country name="États-Unis"><region name="État de New York"><name sortKey="El Sadr, Wafaa M" sort="El Sadr, Wafaa M" uniqKey="El Sadr W" first="Wafaa M." last="El-Sadr">Wafaa M. El-Sadr</name>
</region>
</country>
<country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="De Wit, Stephane" sort="De Wit, Stephane" uniqKey="De Wit S" first="Stephane" last="De Wit">Stephane De Wit</name>
</region>
</country>
<country name="Suisse"><noRegion><name sortKey="Weber, Rainer" sort="Weber, Rainer" uniqKey="Weber R" first="Rainer" last="Weber">Rainer Weber</name>
</noRegion>
</country>
<country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Fontas, Eric" sort="Fontas, Eric" uniqKey="Fontas E" first="Eric" last="Fontas">Eric Fontas</name>
</region>
<name sortKey="Bonnet, Fabrice" sort="Bonnet, Fabrice" uniqKey="Bonnet F" first="Fabrice" last="Bonnet">Fabrice Bonnet</name>
<name sortKey="Bonnet, Fabrice" sort="Bonnet, Fabrice" uniqKey="Bonnet F" first="Fabrice" last="Bonnet">Fabrice Bonnet</name>
</country>
<country name="Pays-Bas"><region name="Hollande-Septentrionale"><name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name>
</region>
<name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name>
<name sortKey="Reiss, Peter" sort="Reiss, Peter" uniqKey="Reiss P" first="Peter" last="Reiss">Peter Reiss</name>
</country>
</tree>
</affiliations>
</record>

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   |texte=   Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study
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Serveur d'exploration sur les relations entre la France et l'Australie

Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study

Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study

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	Serveur d'exploration sur les relations entre la France et l'Australie
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