Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: results from the SIMONE study.
OBJECTIVE
To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings.


METHODS
Multicenter, nationwide cross-sectional study.


METHODS
Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms ("PROCAM", "PROGETTO CUORE", "SCORE"); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD >or=10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients.


RESULTS
A total of 1230 HIV infected patients (72% males, mean age of 43+/-9 years), 185 of whom treatment-naive, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4+/-7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n=142) had both a FRS >or=10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p<0.001).


CONCLUSIONS
The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile.
De Socio
Giuseppe Vittorio L
GV
Department of Infectious Diseases, Santa Maria Hospital, Perugia, Italy. giuseppedesocio@yahoo.it
Parruti
Giustino
G
Quirino
Tiziana
T
Ricci
Elena
E
Schillaci
Giuseppe
G
Adriani
Beatrice
B
Marconi
Patrizia
P
Franzetti
Marzia
M
Martinelli
Canio
C
Vichi
Francesca
F
Penco
Giovanni
G
Sfara
Claudio
C
Madeddu
Giordano
G
Bonfanti
Paolo
P
D000328:Adult; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000821:virology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1; D039682:HIV-Associated Lipodystrophy Syndrome / Q000453:epidemiology / Q000821:virology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology