2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

What percentage of MIs among PLWH are type 2 vs type 1?

• <1% • 1-10%

• 10-40% • 40-60% • >60% • 3.14159265359

Slide13of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

What is the most common cause of type 2 MI among PLWH?

• Sepsis • Cocaine-inducted vasospasm • Politics • GI bleed

Slide14of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.

CNICS MI Central Adjudication Protocol ▪ Based on traditional MI protocols (e.g. MESA) to facilitate comparisons with HIV-uninfected populations. 2-step protocol ▪ Ascertainment: Potential events identified centrally including diagnoses, cardiac enzymes, cardiac procedures such as CABG ▪ Site assembled de-identified packets: notes, ECGs, procedures, labs ▪ Exposures (ARVs) redacted from packets ▪ Central Adjudication: 2 reviewers per packet, 3rd if discrepancies ▪ Enter standardized data required to define an MI into a web application enabling application of multiple operational definitions of MI ▪ Identify events that were likely falsely positive rather than true events: Most often isolated troponin elevations with a reason for a falsely positive troponin value such as renal failure or pericarditis ▪ Categorize each probable or definite MI event as 1 ° (Type 1) vs. 2 ° (Type 2), and identify causes for each 2 ° MI event

Slide15of 43FromHMCrane, MD inNewOrleans, LA, December 4-7, 2019, Ryan WhiteHIV/AIDS ProgramCLINICAL CONFERENCE, IAS  USA.