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Ciccarone Articles

Ciccarone Center Research

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HIV

Landmark Article

Low free testosterone in HIV-infected men is not associated with subclinical cardiovascular disease.
By: Monroe AK, Dobs AS, Xu X, Palella FJ, Kingsley LA, Post WS, Witt MD, Brown TT.

Low testosterone (T) is associated with cardiovascular disease (CVD) and increased mortality in the general population; however, the impact of T on subclinical CVD in HIV disease is unknown. This study examined the relationships among free testosterone (FT), subclinical CVD, and HIV disease. Compared with HIV-uninfected men, HIV-infected men had lower FT, as well as more prevalent carotid lesions. In both groups, FT was not associated with CAC presence, log carotid IMT, or carotid lesion presence, suggesting that FT does not influence subclinical CVD in this population of men with and at risk for HIV infection.

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Vitamin D deficiency is associated with silent coronary artery disease in cardiovascularly asymptomatic African-Americans with HIV infection.
By: Lai H, Gerstenblith G, Fishman EK, Brinker J, Kickler T, Tong W, Bhatia S, Hong T, Chen S, Li J, Detrick B, Lai S.
Both vitamin D deficiency and silent CAD are prevalent in HIV-infected African-Americans. In addition to management of traditional CAD risk factors and substance abuse, vitamin D deficiency should be evaluated in HIV-infected African-Americans. These data support the conduct of a prospective trial of vitamin D in this high-risk patient population.
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Vitamin D deficiency is associated with the development of subclinical coronary artery disease in African-Americans with HIV infection: a preliminary study.
By: Lai H, Detrick B, Fishman EK, Gerstenblith G, Brinker JA, Hollis BW, Bartlett J, Cofrancesco J Jr, Tong W, Tai H, Chen S, Bhatia S, Lai S.
The incidence of subclinical CAD in African-Americans with HIV infection is provocatively high. Larger studies are warranted to confirm the role of vitamin D deficiency in the development of CAD in HIV-infected African-Americans.
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Adverse outcome analyses of observational data: assessing cardiovascular risk in HIV disease.
By: Triant VA, Josephson F, Rochester CG, Althoff KN, Marcus K, Munk R, Cooper C, D’Agostino RB, Costagliola D, Sabin CA, Williams PL, Hughes S, Post WS, Chandra-Strobos N, Guaraldi G, Young SS, Obenchain R, Bedimo R, Miller V, Strobos J.

Clinical decisions are ideally based on randomized trials but must often rely on observational data analyses, which are less straightforward and more influenced by methodology. The authors, from a series of expert roundtables convened by the Forum for Collaborative HIV Research on the use of observational studies to assess cardiovascular disease risk in human immunodeficiency virus infection, recommend that clinicians who review or interpret epidemiological publications consider 7 key statistical issues: (1) clear explanation of confounding and adjustment; (2) handling and impact of missing data; (3) consistency and clinical relevance of outcome measurements and covariate risk factors; (4) multivariate modeling techniques including time-dependent variables; (5) how multiple testing is addressed; (6) distinction between statistical and clinical significance; and (7) need for confirmation from independent databases. Recommendations to permit better understanding of potential methodological limitations include both responsible public access to de-identified source data, where permitted, and exploration of novel statistical methods.

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Predicting and preventing cardiovascular disease in HIV-infected patients.
By: Post WS.
In the absence of specific randomized trials in the HIV-infected population, HIV-infected persons should be treated for cardiovascular risk factors according to current national guidelines for reducing risk, including those for aspirin use and for treatment of dyslipidemia, hypertension, and metabolic syndrome.
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