The cardiovascular risk management for people living with HIV in Europe: how well are we doing?

OBJECTIVES: HIV has become a chronic condition associated with comorbidities. We investigatedcardiovascular (CV)risk and risk modification in a European HIV-Cohort. METHODS: EuroSIDA patients (from 1/1/2000) for whom CV-risk could be calculated (D:A:D risk equation) were included in the analysis. Moderate to high risk was defined as 5-year CV risk >5% and risk modification as two measurements meeting the European AIDSClinical Society guidelines. Factors associated with risk development and modifications were investigated using Poisson regression. RESULTS: Of 8762 individuals, 32.1% were hypertensive, 45.0% had high cholesterol, 47.4% were current smokers, and 27.1% were overweight. 1504 (17.2%) had a 5-year CV-risk of > 5%. Of 7258 individuals with a 5-year risk 5%, (6.53/100 person-years). These patients were more likely to be older, men, living in East Europe, with traditional CV-risk factors. Men who have sex with men, with longer exposure to antiretroviral therapy,low CD4 nadir, higher current CD4, and prior AIDs events were more likely to develop CV-risk. Those on antihypertensive treatment and living in central Europe wereless likely to develop CV-risk. Of those clinically indicated for risk modification, 1205/2077(58.0%) successfully modified BP; 1283/3919(32.8%) stopped smoking; 277/1394(19.9%) modified cholesterol and 543/2163(25.1%) reduced their BMI. There was variation in modification of individual risk factors, by gender, age, HIV related factors, and region of follow-up. Risk modification for BP and smoking improved over time (p < 0.001). CONCLUSION: CV-risk was common. More than half modified their CV risk and this improved over time.