Prediction of cardiovascular disease risk using framingham and data on adverse effect of antiretroviral drugs risk equation in relation to lipodystrophy in HIV patients on highly active antiretroviral therapy

Background: In the era of high active antiretroviral therapy (HAART), with increasing survival of HIV patients, cardiovascular risk has emerged as a leading health issue. Aims: This study aims to predict the 10-year cardiovascular disease risk in HIV patients using the Framingham risk score and its modification for HIV-infected patients on HAART, that is, the data on adverse effect of antiretroviral drugs (DAD) prediction equation. Setting and Design: This is a case control study. Materials and Methods: The present study included 320 subjects (220 HIV infected cases and 100 age, sex and body mass index matched HIV noninfected healthy controls) and was conducted in a tertiary care centre in western Rajasthan. All the patients were subjected to a detailed clinical history, complete physical examination and evaluation of laboratory parameters. We calculated Framingham risk score and DAD prediction equation for these patients and compared these scores between patients on HAART with lipodystrophy, those without lipodystrophy, HAART naive and healthy controls. Statistical Analysis: Unpaired t -test was used and statistical analysis was performed using SPSS version 20. Results: In our study, 46.67% patients on HAART developed lipodystrophy, of which 17.72% had moderate-to-high risk of cardiovascular risk according to Framingham risk score, which is significantly higher than in patients without lipodystrophy and controls (3.3% and 6%, respectively). Similar high risk was also seen with DAD score. The various risk factors also showed a positive correlation with duration of HAART. Conclusion: Our study emphasizes the need for early recognition of cardiovascular risk in HIV-infected patients on HAART, especially in those with lipodystrophy and advocates effective use of risk calculators in these patients.