Cardiovascular Risk Evaluation and Anti-retroviral Therapy Effects in an HIV cohort: implications for clinical management: The CREATE 1 study

Michael Aboud (1) , Ali Elgalib (1) , Laura Pomeroy (1) , George Panayiotakopoulos (1) , Elias Skopelitis (1) , Alastair Duncan (1) , Ranjababu Kulasegaram (1) , Caroline Dimian (2) , Fiona Lampe (3) , Anthony S Wierzbicki (4) , Barry Peters (5)

1 GU Medicine
2 GU Medicine
3 Population Sciences
4 Chemical Pathology
5 Infectious Diseases

Aims: To determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. Methods: A cross-sectional study within a large inner city Hospital and neighbouring district hospital. 1021 HIV positive outpatients representative of the complete cohort; 990 had no previous CVD. We recorded demographics, highly active antiretroviral therapy (HAART) history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. Results: The non-CVD cohort (n=990) was 74% male, 51% Caucasian and 73.1% were on HAART. Mean age was 41±9 years, systolic blood pressure 120±14mmHg, total cholesterol 4.70±1.05mmol/L, HDL-C 1.32±0.48 mmol/L and 37% smoked. Median CVD risk (n=973) was 4 (0-56)% in men and 1.4(0-37) % in women; CHD risks were 3.5(0-36)% and 0.6(0-16)%. CVD risk was >20% in 6% of men and 1% of women and >10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p<0.001) was strongly related to duration of therapy. Conclusions: Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. Discussion: Regular CHD and/or CVD risk assessment should be performed on patients with HIV. The effect of different HAART regimens on CHD risk should be considered when selecting therapy. Clinical Trials.gov identifier: NCT0105092

Mots clés: Medicine

Michael Aboud, Ali Elgalib, Laura Pomeroy, George Panayiotakopoulos, Elias Skopelitis, et al.. Cardiovascular Risk Evaluation and Anti-retroviral Therapy Effects in an HIV cohort: implications for clinical management: The CREATE 1 study. International Journal of Clinical Practice, 2010, 64 (9), pp.1252. ⟨10.1111/j.1742-1241.2010.02424.x⟩. ⟨hal-00599540⟩