Cardiovascular risk assessment in people living with HIV compared to the general population. European Journal of Preventive Cardiology
Delabays et al. aimed to assess and to compare the accuracy of cardiovascular risk scores in people living with HIV (PLWH) and individuals from the general population using the CoLaus/PsyCoLaus cohort. The CoLaus/PsyCoLaus study is a Swiss population-based prospective cohort investigating clinical, psychological, genetic, and social determinants of cardiovascular diseases.
The authors used three validated prediction scores: i) the Data-Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) risk score, ii) the Systematic COronary Risk Evaluation 2 score (SCORE2) and iii) the Pooled Cohort Equations (PCE) score. All scores were calculated in participants free from atherosclerotic cardiovascular disease (ASCVD) between 2003 and 2009. They tested discrimination and calibration, and the value of adding HIV-specific factors to scores using the net reclassification improvement (NRI).
In total, 6’373 [mean age, 40.6 years (SD, 9.9)] PLWH from the Swiss HIV Cohort Study (SHCS) and 5’403 [52.8 years (SD, 10.7)] individuals from the CoLaus/PsyCoLaus study were eligible for analysis. During mean follow-ups of 13.5 (SD, 4.1) in SHCS and 9.9 (SD, 2.3) years in CoLaus/PsyCoLaus study, 533 (8.4%) and 374 (6.9%) people developed an incident ASCVD, respectively. This translated into age-adjusted incidence rates of 12.9 and 7.5 per 1000 person-year, respectively. In SHCS, SCORE2, PCE, and D:A:D presented comparable discriminative capacities [area under the receiver operating characteristic curve of 0.745 (95% confidence interval, CI, 0.723–0.767), 0.757 (95% CI, 0.736–0.777), and 0.763 (95% CI, 0.743–0.783)]. Adding HIV-specific variables (CD4 nadir and abacavir exposure) to SCORE2 and PCE resulted in an NRI of -0.1% (95% CI, -1.24to 1, P = 0.83) and of 2.7% (95% CI, 0.3–5.1, P = 0.03), respectively.
In conclusion, the study shows that PLWH are still presenting a two-fold higher incidence rate of ASCVD compared to individuals from the general population, making the implementation and validation of prevention tools an urgent need. In people taking lipid-lowering treatments, PLWH less often reached LDL-C targets compared to individuals from the general population in the same category of risk. Using either SCORE2 or PCE in PLWH is valid to predict ASCVD, notably due to their set of variables that are easier to use compared to more complex scores integrating HIV-specific data. Adding HIV-specific factors to scores developed for the general population did not result in a clinically significant improvement.