Introduction. With the widespread availability of early and effective antiretroviral therapy (ART), HIV has shifted from being a progressive and fatal disease to a manageable chronic condition, characterized by a high risk of chronic comorbidities, including cardiovascular diseases (CVD). Therefore, it is crucial to assess and aggressively treat all cardiovascular risk factors in people with HIV (PWH) as early as possible. The European AIDS Clinical Society (EACS) guidelines recommend calculating cardiovascular risk annually in PWH using the SCORE2 or SCORE2-OP models. Additionally, they recommend initiating moderate-intensity statin therapy in PWH over the age of 40. This recommendation is particularly strong for individuals in the very high and high-risk categories. Aim of the study. The primary objective of this study is to assess cardiovascular risk, calculated using the SCORE2 or SCORE2-OP models, and its pharmacological management through statin treatment in a population of adult patients with HIV infection who are undergoing antiretroviral therapy and are regularly followed at the Infectious Diseases Unit of Ca' Foncello Hospital in Treviso. The secondary aim is to analyze possible associations between clinical viroimmunological parameters and risk categories. Materials and methods. A total of 149 patients with chronic HIV infection, aged over 40 years and on ART, were enrolled in the study. For each patient, the following data were extracted from their medical records: demographic information, systolic blood pressure, BMI, blood glucose levels, lipid profile, viroimmunological parameters, statin prescription status, and the presence or absence of cardiovascular disease (CVD), diabetes mellitus (DM), or familial hypercholesterolemia. For all patients without confirmed DM or CVD, a 10-year CVD risk was calculated using the SCORE2 model (for individuals aged 40 to 69 years) and the SCORE2-OP model (for those aged ≥50 years). Based on age group and calculated risk, patients were classified into three risk categories: very high, high, and low-to-moderate. Results. Among the 149 enrolled patients, 115 were male and 34 were female, with a median age of 55 years (IQR, 50–61). Two groups of patients were identified: 120 without the comorbidities listed and 29 with at least one of the conditions. Of the 120 patients without comorbidities, 41.7% were classified as low-to-moderate risk, 43.3% as high risk, and 15% as very high risk. Higher HIV-1 RNA levels at the time of diagnosis, older age at diagnosis, and older age at the start of ART were significantly associated with a higher risk category. In the studied population, only 33.6% (n=50) were currently on statin therapy. Among patients in the high-risk and very high-risk categories, only 9.6% and 5.6%, respectively, had achieved target LDL cholesterol levels. Additionally, 10.01% of patients had refused statin therapy. Conclusion. The low prescription rate of statins remains a significant concern. Future research in people with HIV should focus on improving the assessment of ASCVD risk and identifying the causes of statin underprescription to bridge this gap in care between people living with HIV and the general population.
Introduzione. Con la diffusione di una terapia antiretrovirale (ART) precoce ed efficace, l'HIV è passato dall’essere una malattia progressiva e fatale ad una condizione cronica e gestibile, caratterizzata da un rischio elevato di comorbilità croniche, tra cui le malattie cardiovascolari (CVD). Pertanto, è fondamentale valutare e trattare precocemente e in modo aggressivo tutti i fattori di rischio per le malattie cardiovascolari nelle persone con HIV (people living with HIV, PLWH). Le linee guida EASC (European AIDS Clinical Society) raccomandano di calcolare annualmente il rischio cardiovascolare nelle PLWH usando i modelli SCORE2 o SCORE2-OP e inoltre raccomandano di iniziare la terapia una statina a moderata intensità nelle PLWH di età superiore a 40 anni. La raccomandazione è più forte nelle categorie a rischio molto alto ed alto. Scopo dello studio. L’obiettivo primario è la valutazione del rischio cardiovascolare calcolato mediante gli score SCORE2 o SCORE2-OP e della sua gestione farmacologica mediante trattamento con statine in una popolazione di pazienti adulti con infezione da virus HIV in terapia antiretrovirale e regolarmente afferenti all’ambulatorio della Unità Operativa Complessa di Malattie Infettive dell’ospedale Ca' Foncello di Treviso. Lo scopo secondario è l’analisi delle possibili associazioni tra parametri viroimmunologici clinici e le classi di rischio. Materiali e metodi. Sono stati arruolati 149 pazienti con infezione cronica da HIV di età superiore a 40 anni e in terapia ART. Dalla cartella clinica sono state ricavate per ciascuno di essi le informazioni anagrafiche, la pressione arteriosa sistolica, il BMI, la glicemia, il profilo lipidico, i parametri viroimmunologici, la prescrizione o meno di statine e la presenza o meno di CVD, diabete mellito (DM) o ipercolesterolemia familiare. Per tutti i pazienti senza DM e CVD accertata, è stato calcolato il rischio CVD a 10 anni, usando il modello SCORE2 (per le persone di età compresa tra i 40 e i 69 anni) e lo SCORE2-OP (per le persone di età ≥ 50 anni) e in base al gruppo di età i pazienti sono stati suddivisi in tre categorie di rischio: molto alto, alto e basso-moderato. Risultati. Dei 149 pazienti arruolati 115 erano maschi e 34 erano femmine. l’età mediana era di 55 anni (IQR, 50-61). Sono stati identificati due gruppi di pazienti: 120 pazienti che non hanno le comorbilità descritte e 29 che sono affetti da almeno una delle patologie. Dai 120 pazienti senza comorbilità, 41,7% sono stati classificati come pazienti a rischio basso-moderato CVD, 43,3% ad alto rischio e 15% come pazienti a rischio molto alto. Livelli di HIV-1 RNA più alti al momento della diagnosi e un’età più elevata alla diagnosi e all’inizio dell’ART si associavano significativamente ad una categoria di rischio più alta. Nella popolazione considerata, solo il 33,6% (n=50) era attualmente in terapia con una statina. Solo il 9,6% e il 5,6 % dei pazienti rispettivamente della categoria ad alto rischio e a rischio molto alto aveva raggiunto i livelli target del colesterolo LDL. Il 10,01% dei pazienti aveva rifiutato la terapia. Conclusioni. La maggioranza dei pazienti è a significativo rischio di sviluppare CVD. La bassa prescrizione di statine si conferma un problema rilevante. La ricerca futura nelle persone con HIV dovrebbe concentrarsi sul miglioramento della valutazione del rischio di CVD e sulla determinazione delle cause della sottoprescrizione delle statine.
Rischio cardiovascolare nei pazienti HIV positivi in terapia antiretrovirale e ruolo delle statine: studio retrospettivo monocentrico.
ZADEJA, ALBA
2023/2024
Abstract
Introduction. With the widespread availability of early and effective antiretroviral therapy (ART), HIV has shifted from being a progressive and fatal disease to a manageable chronic condition, characterized by a high risk of chronic comorbidities, including cardiovascular diseases (CVD). Therefore, it is crucial to assess and aggressively treat all cardiovascular risk factors in people with HIV (PWH) as early as possible. The European AIDS Clinical Society (EACS) guidelines recommend calculating cardiovascular risk annually in PWH using the SCORE2 or SCORE2-OP models. Additionally, they recommend initiating moderate-intensity statin therapy in PWH over the age of 40. This recommendation is particularly strong for individuals in the very high and high-risk categories. Aim of the study. The primary objective of this study is to assess cardiovascular risk, calculated using the SCORE2 or SCORE2-OP models, and its pharmacological management through statin treatment in a population of adult patients with HIV infection who are undergoing antiretroviral therapy and are regularly followed at the Infectious Diseases Unit of Ca' Foncello Hospital in Treviso. The secondary aim is to analyze possible associations between clinical viroimmunological parameters and risk categories. Materials and methods. A total of 149 patients with chronic HIV infection, aged over 40 years and on ART, were enrolled in the study. For each patient, the following data were extracted from their medical records: demographic information, systolic blood pressure, BMI, blood glucose levels, lipid profile, viroimmunological parameters, statin prescription status, and the presence or absence of cardiovascular disease (CVD), diabetes mellitus (DM), or familial hypercholesterolemia. For all patients without confirmed DM or CVD, a 10-year CVD risk was calculated using the SCORE2 model (for individuals aged 40 to 69 years) and the SCORE2-OP model (for those aged ≥50 years). Based on age group and calculated risk, patients were classified into three risk categories: very high, high, and low-to-moderate. Results. Among the 149 enrolled patients, 115 were male and 34 were female, with a median age of 55 years (IQR, 50–61). Two groups of patients were identified: 120 without the comorbidities listed and 29 with at least one of the conditions. Of the 120 patients without comorbidities, 41.7% were classified as low-to-moderate risk, 43.3% as high risk, and 15% as very high risk. Higher HIV-1 RNA levels at the time of diagnosis, older age at diagnosis, and older age at the start of ART were significantly associated with a higher risk category. In the studied population, only 33.6% (n=50) were currently on statin therapy. Among patients in the high-risk and very high-risk categories, only 9.6% and 5.6%, respectively, had achieved target LDL cholesterol levels. Additionally, 10.01% of patients had refused statin therapy. Conclusion. The low prescription rate of statins remains a significant concern. Future research in people with HIV should focus on improving the assessment of ASCVD risk and identifying the causes of statin underprescription to bridge this gap in care between people living with HIV and the general population.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/78908