2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Risk score comparisons

Framingham

DAD

ATP3

ASCVD

AUC

CI

AUC

CI

AUC

CI

AUC

CI

Type 1 0.725 0.69,0.77 0.741 0.70,0.78 0.735 0.70,0.77 0.750 0.71,0.79

Type 2 0.634* 0.58,0.69 0.626* 0.57,0.68 0.627* 0.57,0.68 0.720 0.67,0.77

0.687* 0.65,0.72 0.693* 0.66,0.73 0.690* 0.66,0.72 0.740 0.71,0.77

AllMI

*AUC significantly different from ASCVDAUC

▪ Some variations across risk measures to be expected given differences in the outcome (i.e. predicted CVD vs. MI) ▪ Adding HIV-specific variables to the DAD score did not improve discrimination compared with ASCVD ▪ Would inclusion of different HIV-specific measures improve discrimination? ▪ ASCVDperformed as well or better than others across all MI events and had superior performance for Type 2 MI ▪ While there is room for improvement, does not mean that they cannotbe used to improve for clinical care

Slide37of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

ASCVD in PLWH

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Harrell’s C=0.76 GND= 6.4 (P=.50) Slope=0.857 Intercept=0.009

Harrell’s C=0.74 GND= 10.3 (.24) Slope=0.589 Intercept=0.046

Harrell’s C=0.64 GND= 12.9 (<0.01) Slope=0.442 Intercept=0.012

Harrell’s C=0.74 GND= 8.0 (.24) Slope=0.553 Intercept=0.077

Feinstein MJ, etal. JAMA Cardiology

Slide38of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

Roadmap ▪ Why do we care? ▫ HIV infected vs. uninfected, incidence

▪ MI types in HIV ▫ Universal MI definition ▫ CNICS MI adjudication ▫ Type 1 vs. Type 2 MIs ▪ Why ▪ Other CVD ▪ What do we do? ▫ Risk scores ▪ Summary

Slide39of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.