title: 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.
authors.affiliation: From the Department of Neurology (F.J.M.), Massachusetts General Hospital, Boston; Departments of International Health (F.J.M., N.S.), and Epidemiology (W.S.P., A.G.A.), Bloomberg School of Public Health, and Department of Medicine, Division of Cardiology (W.S.P.), the Johns Hopkins University, Baltimore; Department of Neurology (N.S., B.R.S.), the Johns Hopkins Hospital, Baltimore, MD; Departments of Neurology, Psychiatry, and Psychology (J.T.B.), University of Pittsburgh, PA; Department of Epidemiology, School of Public Health (R.D.), and Department of Medicine, School of Medicine (R.D.), University of California, Los Angeles; Department of Psychiatry (E.M.), Rush University Medical Center, Chicago; Feinberg School of Medicine (J.P.P.), Division of Infectious Diseases, Northwestern University, Chicago, IL; and Department of Biostatistics and Epidemiology (R.T.S.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
authors.forename: Wendy S
authors.initials: WS
authors.lastname: Post
authors.forename: Ned
authors.initials: N
authors.lastname: Sacktor
authors.forename: Alison G
authors.initials: AG
authors.lastname: Abraham
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.forename: Bryan R
authors.initials: BR
authors.lastname: Smith
authors.forename: Roger
authors.initials: R
authors.lastname: Detels
authors.forename: Eileen
authors.initials: E
authors.lastname: Martin
authors.forename: John P
authors.initials: JP
authors.lastname: Phair
authors.forename: Russell T
authors.initials: RT
authors.lastname: Shinohara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult