The Framingham score -- a widely-used measure of cardiovascular disease risk -- may underestimate that risk in people living with HIV (PLWH), new research suggests.
The study by Haijiang Lin et al, published in The Lancet, compared carotid intima thickness, a measure of subclinical atherosclerosis, in 1,425 PLWH and 2,850 matched HIV-negative people. Across most age groups, significantly more PLWH showed signs of atherosclerosis than their HIV-negative peers. Of note, that correlation did not hold in the 60-75-year-old group, possibly because the higher prevalence of traditional cardiovascular risk factors at older ages "overshadows" the effect of serostatus.
Among young people (18-29 years), 16% of PLWH had subclinical atherosclerosis, even though none of them had been living with HIV since infancy. The reasons behind this finding, as well as the potential for progression to cardiovascular events, remain to be investigated, study authors noted.
"HIV infection itself renders a higher than expected cardiovascular risk," wrote Esteban Martinez of the University of Barcelona in a commentary accompanying the Chinese study. "Recommending standard preventive measures for people with HIV … intuitively makes sense, but it seems necessary that people with HIV should have earlier and more aggressive interventions to reduce HIV-related cardiovascular disease risk beyond suppressive [antiretroviral therapy]."