CVD and CKD Risks Should Be Evaluated Together in HIV Patients

Patients being treated for HIV with a high risk for cardiovascular disease (CVD) and chronic kidney disease (CKD) have a significantly higher risk of future CVD and CKD events than those with high predicted risk for CVD or CKD alone, according to the findings of a recent study.

In their study, the researchers calculated the risk for CVD and CKD using data from 27,215 participants with HIV involved in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) (74% male, median age 42 years). They calculated the CVD and CKD event rates by predicted 5-year CVD and CKD risk groups and used fitted Poisson models to assess whether CVD and CKD risk groups effects were multiplicative.
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Overall, the D:A:D risk equations predicted 3560 participants (13.1%) with high CVD risk, 4996 participants (18.4%) with high CKD risk, and 1585 participants (5.8%) with both high CVD and CKD risk. The CVD and CKD event rates by predicted risk group were found to be multiplicative.

Compared with participants with the lowest CVD risk, those with the highest had a 5.63-fold increase risk for CKD events. Additionally, those with the highest CKD risk had a 1.31-fold increase risk for CVD events compared with those with the lowest risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects with no evidence of interaction.

“HIV-positive people not uncommonly have high predicted CVD and/or CKD risk; these interact to create substantial risks for future morbid events,” the researchers concluded.

“This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritize addressing modifiable risks for CVD and CKD in HIV-positive people.”

—Melissa Weiss

Reference:

Boyd MA, Mocroft A, Ryom L, et al. Cardiovascular disease (CVD) and chronic kidney disease (CKD) event rates in HIV-positive persons at high predicted CVD and CKD risk: A prospective analysis of the D:A:D observational study [published online November 7, 2017]. PLOS Medicine. https://doi.org/10.1371/journal.pmed.1002424.