A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men.
BACKGROUND
Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors observed in patients starting HAART.


METHODS
Data from five cohort studies (British Regional Heart Study, Caerphilly and Speedwell Studies, Framingham Offspring Study, Whitehall II) on 13,100 men aged 40-70 and 114,443 years of follow up were used. CHD was defined as myocardial infarction or death from CHD. Model fit was assessed using the Akaike Information Criterion; generalizability across cohorts was examined using internal-external cross-validation.


RESULTS
A parametric model based on the Gompertz distribution generalized best. Variables included in the model were systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, diabetes mellitus, body mass index and smoking status. Compared with patients not on HAART, the estimated CHD hazard ratio (HR) for patients on HAART was 1.46 (95% CI 1.15-1.86) for moderate and 2.48 (95% CI 1.76-3.51) for severe metabolic complications.


CONCLUSIONS
The change in the risk of CHD in HIV-infected men starting HAART can be estimated based on typical changes in risk factors, assuming that HRs estimated using data from non-infected men are applicable to HIV-infected men. Based on this model the risk of CHD is likely to increase, but increases may often be modest, and could be offset by lifestyle changes.
May
Margaret
M
Department of Social Medicine, University of Bristol, UK.
Sterne
Jonathan A C
JA
Shipley
Martin
M
Brunner
Eric
E
d'Agostino
Ralph
R
Whincup
Peter
P
Ben-Shlomo
Yoav
Y
Carr
Andrew
A
Ledergerber
Bruno
B
Lundgren
Jens D
JD
Phillips
Andrew N
AN
Massaro
Joseph
J
Egger
Matthias
M
D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003327:Coronary Disease / Q000139:chemically induced / Q000209:etiology* / Q000821:virology; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D006113:United Kingdom
D044966:Anti-Retroviral Agents