Predicting the risk of cardiovascular disease in HIV-infected patients: the Data collection on Adverse Effects of Anti-HIV Drugs Study

• DOI: 10.1097/hjr.0b013e328336a150
• Publication Date: 2010-06-11T11:29:23Z
• Authors: Nina Friis-Møller; Rodolphe Thiébaut; Peter Reiss; Rainer Weber; Antonella D'Armin...; Stephane De Wit; Wafaa El-Sadr; Eric Fontas; Signe Worm; Ole Kirk; Andrew Phillips; Caroline A. Sabin; Jens D. Lundgren; Matthew G. Law
• Keywords: Male; Time Factors; Epidemiology; Cardiologie et circulation; Myocardial Infarction; N4i 1: Pathogenesis and modulation of inflammation; Coronary Disease; HIV Infections; Antiretroviral drug; 10234 Clinic for Infectious Diseases; 0302 clinical medicine; Models; Risk Factors; HIV Infection; Prospective Studies; Epidémiologie; Statistical; Middle Aged; 3. Good health; prediction model; Europe; Treatment Outcome; Combination; Drug Therapy, Combination; Female; Cardiology and Cardiovascular Medicine; Human; cardiovascular risk; Adult; antiretroviral drugs cardiovascular risk HIV prediction model coronary-heart-disease combination antiretroviral therapy reverse-transcriptase inhibitors human-immunodeficiency-virus myocardial-infarction vascular mortality diabetes-mellitus prognostic model individual data blood-pressure; Time Factor; Anti-HIV Agents; Argentina; Reproducibility of Result; 610 Medicine & health; N4i 3: Poverty-related infectious diseases; Settore MED/17 - MALATTIE INFETTIVE; Risk Assessment; Settore MED/07 - MICROBIOLOGIA E MICROBIOLOGIA CLINICA; 2705 Cardiology and Cardiovascular Medicine; 03 medical and health sciences; Drug Therapy; Humans; Risk Assessment; Treatment Outcome; Male; Time Factors; Middle Aged; Models, Statistical; HIV Infections; Female; Risk Factors; Anti-HIV Agents; Drug Therapy, Combination; Australia; Humans; Prospective Studies; Myocardial Infarction; Europe; Argentina; Reproducibility of Results; Adult; Coronary Disease; Models, Statistical; Risk Factor; Australia; HIV; Anti-HIV Agent; Reproducibility of Results; Antiretroviral drugs; cardiovascular risk; HIV; prediction model; Prospective Studie; Antiretroviral drugs; 2713 Epidemiology

HIV-infected patients receiving combination antiretroviral therapy may experience metabolic complications, potentially increasing their risk of cardiovascular diseases (CVDs). Furthermore, exposures to some antiretroviral drugs seem to be independently associated with increased CVD risk. We aimed to develop cardiovascular risk-assessment models tailored to HIV-infected patients.Prospective multinational cohort study. The data set included 22,625 HIV-infected patients from 20 countries in Europe and Australia who were free of CVD at entry into the Data collection on Adverse Effects of Anti-HIV Drugs Study. Using cross-validation methods, separate models were developed to predict the risk of myocardial infarction, coronary heart disease, and a composite CVD endpoint. Model performance was compared with the Framingham score. The models included age, sex, systolic blood pressure, smoking status, family history of CVD, diabetes, total cholesterol, HDL cholesterol and indinavir, lopinavir/r and abacavir exposure. The models performed well with area under the receiver operator curve statistics of 0.783 (range 0.642-0.820) for myocardial infarction, 0.776 (0.670-0.818) for coronary heart disease and 0.769 (0.695-0.824) for CVD. The models estimated more accurately the outcomes in the subgroups than the Framingham score.Risk equations developed from a population of HIV-infected patients, incorporating routinely collected cardiovascular risk parameters and exposure to individual antiretroviral therapy drugs, might be more useful in estimating CVD risks in HIV-infected persons than conventional risk prediction models.