1. Printing: This poster is 48” wide by 36” high. It’s designed to be printed on a large-format printer. Customizing the Content: The placeholders in this poster are formatted for you. Type in the placeholders to add text, or click an icon to add a table, chart, SmartArt graphic, picture or multimedia file. To add or remove bullet points from text, click the Bullets button on the Home tab. If you need more placeholders for titles, content or body text, make a copy of what you need and drag it into place. PowerPoint’s Smart Guides will help you align it with everything else. Want to use your own pictures instead of ours? No problem! Just click a picture, press the Delete key, then click the icon to add your picture. Low Rates of Cholesterol Screening Despite Cardiovascular Risk In Protease-Inhibitor Treated HIV Patients in Botswana Mosepele Mosepele 1,2,3,4, Lucky Mokgatlhe 5,Frank P Hudson 6, Virginia Letsatsi,4 Robert Gross, 7,8 Department of Medicine, University of Botswana, 1 Botswana-Harvard AIDS Partnership, 2 Harvard T. H Chan School of Public Health, 3 Princess Marina Hospital Infectious Disease Care Clinic, Botswana, 4 Department of Biostatistics, University of Botswana, 5 Division of Infectious Diseases, University of North Carolina, USA, 6 Division of Infectious Disease, University of Pennsaylvania Perelman School of Medicine, USA, 7 Botswana-UPenn Partnership, Botswana, 8 Introduction Treatment of Human Immunodeficiency Virus (HIV) with Protease Inhibitors (PIs) is associated with increase in serum cholesterol levels PI induced hypercholesterolemia is strongest among those on first generation ritonavir boosted PIs [commonly used in sub-Saharan Africa] In other settings, use of general population cholesterol guidelines is recommended among HIV patients to reduce cardiovascular (CVD) risk The American Heart Association/American College of Cardiology issued a new cholesterol recommendation (ASCVD) in 2013, which replaced the Framingham risk score (FRS) Our objective was to assess cholesterol screening and ascertain proportion of PI treated HIV-infected patients who would be considered for statin therapy in a clinical HIV-cohort in Botswana based on ASCVD versus FRS Hypotheses Methods Type a brief overview or summary of your project. (Click the Bullets button on the Home tab to remove the bullets.) 50-5941 (11.5) Contact: Mosepele Mosepele MD, MSc Department of Medicine, Faculty of Medicine University of Botswana Phone: +267 355 5589 Email: mosepelemosepelet@gmail.com vtriant@mgh.Harvard.edu vtriant@mgh.Harvard.edu Abstract: WEPDB0106 Study setting was a large referral urban HIV clinic with over 8,000 HIV-infected patients Aimed to screen 400-500 patients over age 21-years on PI-containing ART on consecutive days over 3-6 months during routine clinic visit Data on traditional CVD risk factors was obtained from medical records and brief participant interview Cholesterol screening assessed each year between 2008 and 2011 (as per the 2008 national HIV guideline recommendation) Participants recommended non-fasting lipid profile testing if they did not have a lipid profile within 12 months at time of enrollment Recommendation for evaluation for statin use based on ASCVD risk score as of 2013 and ATP III risk score as of 12/31/2008 Risk score calculated using data from a 12 month window Exclusion criteria: NNRTI-based ART Rates of hypercholesterolemia (>5.0mmol/L), statin use, proportion recommended statin calculated, and agreement between ASCVD & FRS assessed using Kappa statistic Cholesterol screening rate are low in usual clinical practice among PI-treated HIV-infected patients More patients will be recommended for statin therapy evaluation based on ASCVD than FRS

2. Printing: This poster is 48” wide by 36” high. It’s designed to be printed on a large-format printer. Customizing the Content: The placeholders in this poster are formatted for you. Type in the placeholders to add text, or click an icon to add a table, chart, SmartArt graphic, picture or multimedia file. To add or remove bullet points from text, click the Bullets button on the Home tab. If you need more placeholders for titles, content or body text, make a copy of what you need and drag it into place. PowerPoint’s Smart Guides will help you align it with everything else. Want to use your own pictures instead of ours? No problem! Just click a picture, press the Delete key, then click the icon to add your picture. Low Rates of Cholesterol Screening Despite Cardiovascular Risk In Protease-Inhibitor Treated HIV Patients in Botswana Mosepele Mosepele 1,2,3,4, Lucky Mokgatlhe 5,Frank P Hudson 6, Virginia Letsatsi,4 Robert Gross, 7,8 Department of Medicine, University of Botswana, 1 Botswana-Harvard AIDS Partnership, 2 Harvard T. H Chan School of Public Health, 3 Princess Marina Hospital Infectious Disease Care Clinic, Botswana, 4 Department of Biostatistics, University of Botswana, 5 Division of Infectious Diseases, University of North Carolina, USA, 6 Division of Infectious Disease, University of Pennsaylvania Perelman School of Medicine, USA, 7 Botswana-UPenn Partnership, Botswana, 8 Type a brief overview or summary of your project. (Click the Bullets button on the Home tab to remove the bullets.) Results Conclusion Hypercholesterolemia was detected among 94 (31%) of participants, in contrast to baseline hypercholesterolemia rate of 2.4% in the medical records There was moderate agreement in recommendation for statin therapy: 14.3% by ASCVD versus 9.4% by FRS – [Kappa statistic 0.68, 95% CI 0.54-0.82, p<0.001] Provider initiated cholesterol screening during routine clinical care is low in this setting When recommended to go for cholesterol screening in study setting using standard of care procedures, a majority of patients underwent screening Hypercholesterolemia was higher that the documented rate in medical records (2.4% versus 31%) In this setting, ASCVD would result in more patients recommended statin therapy than FRS, a finding that has been observed in other clinical cohorts Interventions are needed to increase cholesterol screening and evaluate strategies for statin prescription for primary CVD risk reduction among HIV-infected patients Acknowledgements Work inspired by Virginia A Triant, MD, MGH/HMS work on CVD epidemiology 50-5941 (11.5) Contact: Mosepele Mosepele MD, MSc Department of Medicine, Faculty of Medicine University of Botswana Phone: +267 355 5589 Email: mosepelemosepelet@gmail.com vtriant@mgh.Harvard.edu vtriant@mgh.Harvard.edu Abstract: WEPDB0106 All DEMOGRAPHICS N375 Female - N (%) 239 (63.7) Age Category - N (%) 21-39167 (46.6) 40-49135 (37.7) 50-5941 (11.5) >6015 (4.2) CVD RISK FACTORS – N (%) Cigarette smoking85 (22.7) HTN34 (9.1) HTN medications31 (91) DM II7 (1.9) DM II medications6 (86) Dyslipidemia9 (2.4) Statin use6 (67) Prior CVD2 (0.005) HIV PARAMETERS- N (%) HIV duration8.9 (2.8) ART duration7.2 (2.2) Baseline CD4118.5 (86.3) CD4 nadir104.9 (75.4) Current CD4513.9 (286.1) Viral load undetectable344 (91.7) CVD RISK PARAMETERS – mean (SD) Systolic blood pressure (mmHg)117.3 (18.3) Diastolic blood pressure (mmHg)72.9 (12.6) Total cholesterol4.6 (1.1) LDL-cholesterol2.8 (0.9) HDL-cholesterol1.3 (0.4) Triglycerides1.7 (1.2) Figure 1. Proportion of patients who were screened for dyslipidemia using usual clinical practice before study enrollment (2008 to 2011) and during study enrollment (2012). Table 1: Patient characteristics. Demographic and clinical characteristics