IJE Advance Access originally published online on July 25, 2007
International Journal of Epidemiology 2007 36(6):1309-1318; doi:10.1093/ije/dym135
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A coronary heart disease risk model for predicting the effect of potent antiretroviral therapy in HIV-1 infected men
1Department of Social Medicine, University of Bristol, UK.
2Department of Epidemiology and Public Health, University College, London, UK.
3Department of Mathematics and Statistics, Boston University, USA.
4Division of Community Health Sciences, St George's Hospital, University of London, UK.
5St Vincent's Hospital and University of New South Wales, Sydney, Australia.
6Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Switzerland.
7Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.
8Royal Free Centre for HIV Medicine & Department of Primary Care and Population Sciences, University College, London, UK.
9Department of Biostatistics, Boston University, USA.
10Institute of Social and Preventive Medicine (ISPM), University of Berne, Switzerland.
*Corresponding author. Institute of Social and Preventive Medicine (ISPM), University of Berne, Finkenhubelweg 11, CH-3012 Bern, Switzerland. E-mail: egger{at}ispm.unibe.ch
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Abstract |
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Background Many HIV-infected patients on highly active antiretroviral therapy (HAART) experience metabolic complications including dyslipidaemia and insulin resistance, which may increase their coronary heart disease (CHD) risk. We developed a prognostic model for CHD tailored to the changes in risk factors observed in patients starting HAART.
Methods Data from five cohort studies (British Regional Heart Study, Caerphilly and Speedwell Studies, Framingham Offspring Study, Whitehall II) on 13 100 men aged 40–70 and 114 443 years of follow up were used. CHD was defined as myocardial infarction or death from CHD. Model fit was assessed using the Akaike Information Criterion; generalizability across cohorts was examined using internal-external cross-validation.
Results A parametric model based on the Gompertz distribution generalized best. Variables included in the model were systolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, diabetes mellitus, body mass index and smoking status. Compared with patients not on HAART, the estimated CHD hazard ratio (HR) for patients on HAART was 1.46 (95% CI 1.15–1.86) for moderate and 2.48 (95% CI 1.76–3.51) for severe metabolic complications.
Conclusions The change in the risk of CHD in HIV-infected men starting HAART can be estimated based on typical changes in risk factors, assuming that HRs estimated using data from non-infected men are applicable to HIV-infected men. Based on this model the risk of CHD is likely to increase, but increases may often be modest, and could be offset by lifestyle changes.
Keywords Highly active antiretroviral therapy, protease inhibitors, non-nucleoside reverse transcriptase inhibitor, coronary heart disease, adverse effects, prognosis, coronary risk factors
Accepted 4 June 2007
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