Identifying HIV patients with an unfavorable cardiovascular risk profile in the clinical practice: Results from the SIMONE study

Objective: To identify and characterize HIV-infected patients at higher cardiovascular risk in ordinary clinical settings. Design: Multicenter, nationwide cross-sectional study. Methods: Consecutive HIV-patients, attending scheduled visits at facilities involved in the Italian coordination group for the study of allergies and HIV infection (CISAI), were included between February and April, 2005. Their 10-year probability of acute coronary events was calculated using the Framingham Risk Score (FRS) as well as 3 other cardiovascular algorithms ("PROCAM", "PROGETTO CUORE", "SCORE"); Metabolic Syndrome (MS) was diagnosed according to the National Cholesterol Education Program definitions. An estimated 10-year CVD ≥10% and/or MS led to the diagnosis of high CV risk. We compared selected clinical features between high- and low-risk patients. Results: A total of 1230 HIV infected patients (72% males, mean age of 43 ± 9 years), 185 of whom treatment-naïve, were evaluated. FRS gave the highest estimate of CV risk. The mean 10-year risk for acute coronary events according to FRS was 7.4 ± 7.0. MS was present in 22% of the observed patients. Accordingly, 443 patients (36%) were classified at high risk. Twelve percent of the patients (n = 142) had both a FRS ≥10% and a diagnosis of MS. The main single predictor of increased cardiovascular risk was smoking (60% of whole sample). A higher prevalence of clinically evident lipodystrophy and a higher CD4 T-cell counts were found both in patients with higher FRS and in patients with high FRS and MS (both p < 0.001). Conclusions: The worst estimation of CV risk was obtained with the FRS algorithm. Clinical evidence of lipodystrophy and higher CD4 T-cell counts were closely associated to a worse cardiovascular risk profile. © 2008 The British Infection Society.