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Published on: November 7, 2017
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Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted
Mark A Boyd1,2, Amanda Mocroft3, Lene Ryom4
1Kirby Institute, University of New South Wales, Sydney, Australia.
Plos Medicine
|November 8, 2017
Summary
Individuals with HIV at high predicted risk for cardiovascular disease (CVD) and chronic kidney disease (CKD) face significantly greater risks for both conditions. Assessing both CVD and CKD risks together is crucial for better management in people with HIV.
Area of Science:
- Cardiology
- Nephrology
- Infectious Diseases (HIV/AIDS)
Background:
- The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study previously established risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD) in people with HIV.
- A hypothesis was formed that individuals with high predicted risk for both CVD and CKD would experience even greater event rates.
Purpose of the Study:
- To evaluate the combined risk of cardiovascular disease (CVD) and chronic kidney disease (CKD) events in HIV-positive individuals with high predicted risk for both conditions.
- To determine if participants with high predicted risk for both CVD and CKD face a greater risk than those with high risk for only one condition.
Main Methods:
- Utilized data from the D:A:D study, including participants with complete risk factor data and confirmed chronic kidney disease (CKD) events (eGFR < 60 ml/min/1.73 m2).
- Calculated cardiovascular disease (CVD) and chronic kidney disease (CKD) risk scores and event rates based on predicted 5-year risk groups (≤1%, >1%-5%, >5%).
- Employed Poisson models to assess the multiplicative effects of CVD and CKD risk groups on event rates.
Main Results:
- Out of 27,215 participants (202,034 person-years), 5.8% were identified as high risk for both CVD and CKD.
- Participants at high CVD risk showed a 5.63-fold increase in CKD events; those at high CKD risk had a 1.31-fold increase in CVD events.
- CVD and CKD risk groups exhibited multiplicative predictive effects, with no significant interaction detected (p=0.329 for CKD, p=0.291 for CVD).
Conclusions:
- Individuals with HIV at high predicted risk for both CVD and CKD experience substantially greater risks for these events.
- Combined assessment of CVD and CKD risk is recommended for people with HIV.
- Clinicians should prioritize addressing modifiable risk factors for both CVD and CKD in this population.
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