Smoking and projected cardiovascular risk in an HIV-positive Asian regional cohort.

OBJECTIVES: The aim of the study was to assess the prevalence and characteristics associated with current smoking in an Asian HIV-positive cohort, to calculate the predictive risks of cardiovascular disease (CVD), coronary heart disease (CHD) and myocardial infarction (MI), and to identify the impact that simulated interventions may have. METHODS: Logistic regression analysis was used to distinguish associated current smoking characteristics. Five-year predictive risks of CVD, CHD and MI and the impact of simulated interventions were calculated utilizing the Data Collection on Adverse Effects of Anti-HIV Drugs Study (D:A:D) algorithm. RESULTS: Smoking status data were collected from 4274 participants and 1496 of these had sufficient data for simulated intervention calculations. Current smoking prevalence in these two groups was similar (23.2% vs. 19.9%, respectively). Characteristics associated with current smoking included age > 50 years compared with 30-39 years [odds ratio (OR) 0.65; 95% confidence interval (CI) 0.51-0.83], HIV exposure through injecting drug use compared with heterosexual exposure (OR 3.03; 95% CI 2.25-4.07), and receiving antiretroviral therapy (ART) at study sites in Singapore, South Korea, Malaysia, Japan and Vietnam in comparison to Thailand (all OR > 2). Women were less likely to smoke than men (OR 0.11; 95% CI 0.08-0.14). In simulated interventions, smoking cessation demonstrated the greatest impact in reducing CVD and CHD risk and closely approximated the impact of switching from abacavir to an alternate antiretroviral in the reduction of 5-year MI risk. CONCLUSIONS: Multiple interventions could reduce CVD, CHD and MI risk in Asian HIV-positive patients, with smoking cessation potentially being the most influential.

Could a cycloplegic agent be replaced by a fogging or a corrective lens in the biometric measurement of the crystalline lens?

This study investigated whether a fogging or a corrective lens could be used to replace a cycloplegic agent in the ultrasonic measurement of crystalline lens thickness in myopia. A group of 28 Hong Kong Chinese adults with myopia was recruited. The crystalline lens thickness of the examined eye was measured by A-scan ultrasonography while the fixating eye was in one of three conditions: fog (+2.00 D fogging lens), full corrective lens, or cycloplegia (50 minutes after instillation of 1% cyclopentolate HCl). We found that the mean lens thickness was significantly different between the three conditions in our myopic subjects. The mean crystalline lens thickness under fogging and corrective lens conditions was significantly greater than the cycloplegic condition by 0.09 mm and 0.11 mm, respectively. The 95% limits of agreement compared to cycloplegia (fogging: -0.32 to +0.14; corrective: -0.35 to +0.13) showed marked intersubject variability, indicating that there is a risk of overestimating the lens thickness when substituting cycloplegia with either a fogging or a corrective lens.