CVD, CKD should be assessed together in HIV-positive patients

HIV-positive patients at predicted risk for cardiovascular disease (CVD) and chronic kidney disease (CKD) are at an even greater risk for CVD and CKD events, according to new research published in PLOS Medicine.

First author Mark A. Boyd, MD, and a team confirmed their hypothesis that predicted risk scores would translate to a higher risk of disease after evaluating a large-scale cohort of 27,215 HIV-positive individuals. Boyd and colleagues drew their pool of participants from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study, which has its own specialized predictive risk models for CVD and CKD in the HIV-positive population.

Nearly 50,000 patients are enrolled in the D:A:D study, which stretches across countries worldwide and aims to establish whether the use of combination antiretroviral therapy is associated with increased risks of conditions like CVD, end-stage renal disease, liver disease, cancer and death. These combination antiretroviral therapies have “transformed the lives of HIV-positive people” in high-income countries, Boyd et al. wrote, but though the drugs have been linked to decreased disease rates and increased life expectancy, evidence also exists that the medication can lead to greater and earlier onset comorbidities.

CVD and CKD are diseases that feed one another, the authors explained—CKD is an established independent risk factor for CVD and the two conditions share a handful of risk factors.

“It is well recognized that the effects of comorbidity may be greater than the effects of the sum of risk of each disease, and that their coexistence may lead to more severe illness, poorer prognosis and premature death,” they wrote.

For their study, the researchers pulled D:A:D participants who had recorded predicted risk scores for CVD and CKD higher than the general HIV-positive population. The risk equations predicted 13.1 percent of those patients at high CVD risk, 18.4 percent at high CKD risk and 5.8 percent at high risk for both diseases. CVD and CKD event rates were calculated by predicted five-year CVD and CKD risk groups and were multiplicative, Boyd and colleagues reported. The strongest finding was that CVD and CKD are especially dangerous when they come hand-in-hand.

The authors said these findings suggest a possible need to monitor HIV-positive patients more closely when it comes to CVD and CKD risk factors.

“We found that people at high predicted risk for both CVD and CKD have substantially greater risks for both CVD and CKD events compared with those at low predicted risk for both outcomes, and compared to those at high predicted risk for only CVD or CKD events,” Boyd et al. wrote. “This suggests that CVD and CKD risk in HIV-positive persons should be assessed together.”