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.
DESIGN: 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.