Data indicate that people living with HIV (PLWHIV) have an increased risk of cardiovascular disease (CVD) when compared with the general population, with traditional CVD risk scores not accurately reflecting this risk. Non-invasive subclinical vascular damage (SVD) biomarkers are valid surrogates of CVD and have been suggested in prior research to be able to stratify CVD risk.

In a 3 year, single-operator study published in the Journal of Acquired Immune Deficiency Syndrome, we assessed whether four widely applied CVD risk scores (Framingham [FRS], Atherosclerotic CVD, Data Collection on Adverse Effects of Anti-HIV Drugs Study, and Greek-specific European Society of Cardiology [ESC] risk scores) could detect the presence, incidence, and progression of arteriosclerosis, atheromatosis, and arterial hypertrophy in PLWHIV and uninfected individuals.

We prospectively examined (at baseline and 3 year follow up) 10 arterial sites, applying five non-invasive vascular biomarkers and measuring the four CVD risk scores at baseline. Our team found that in both PLWHIV and uninfected individuals, the CVD risk scores—apart from ESC—performed differently but reasonably well in identifying the presence of SVD. However, all scores failed to predict the incidence or progression of overall SVD. The most clinically useful biomarkers (carotid plaque/atheromatosis) revealed that only the FRS was able to stratify overall SVDprogression in PLWHIV (11.0% of the low-risk group, 33.3% of the medium risk, and 0.0% of the high-risk).

Physicians should be aware of the increased CVD risk in PLWHIV, and thus, the importance of risk stratification for CVD and early initiation of preventative treatment as necessary in this patient population. As the current cardiovascular risk scores do not appear to fully recognize CVD risk seen in PLHIV, vascular imaging should be incorporated in CVD risk stratification protocols. More accurate HIV-specific CVD risk models are also needed. Until these are developed, FRS appears to be the best available score to optimize treatment and CVD prevention in PLWHIV at medium CVD risk, as one-third of carotid atheromatosis progresses within 3 years.