Tailoring cardiovascular risk prediction for people living with HIV: Evidence from Malaysia

Area of Science:

• Cardiology
• Infectious Diseases
• Public Health

Background:

• People living with HIV (PLHIV) have elevated cardiovascular disease (CVD) risk.
• Targeted CVD prevention strategies are lacking for PLHIV, particularly in Asian populations.
• This study evaluates CVD risk models in PLHIV in Malaysia.

Purpose of the Study:

• To compare the performance of four cardiovascular risk prediction models in people living with HIV (PLHIV) in Malaysia.
• To identify the most accurate and practical model for assessing 5-year CVD risk in this population.

Main Methods:

• Included 6,339 PLHIV aged ≥18 years (2016-2017), excluding those with pre-existing CVD or non-Malaysian nationality.
• Assessed four models: Framingham risk score (FRS), Revised Pooled Cohort Equations (RPCE), and Data Collection on Adverse Effects of Anti-HIV Drugs (D:A:D) full and reduced versions.
• Evaluated model discrimination using c-statistics and calibration using observed-to-expected (O/E) ratios for 5-year CVD events (hospitalization or death).

Main Results:

• 136 (2.1%) PLHIV developed CVD; associated factors included dyslipidemia, hypertension, and diabetes.
• All models demonstrated moderate discrimination (c-statistics 0.75-0.77).
• The D:A:D reduced model showed better calibration (O/E: 1.13) compared to the full D:A:D (1.25), FRS (0.58), and RPCE (0.72), which overestimated risk.

Conclusions:

• The D:A:D reduced model provides the most accurate and practical 5-year cardiovascular risk estimates for PLHIV in Malaysia.
• This model supports scalable cardiovascular risk assessment within HIV care programs.
• Improved risk stratification can enhance targeted CVD prevention strategies for PLHIV.