Evaluation of cardiovascular disease risk in older patients with HIV infection on antiretroviral therapy

Background The increasing number of older patients (pts) with HIV infection, coupled with the prevalence of cardiovascular disease (CVD) at this age, and the side effects of antiretroviral therapy (ART), mainly related to cholesterol levels, led us to select them as an at-risk population for clinical drug monitoring. Purpose Assessment of cardiovascular risk in older patients infected by HIV treated with antiretrovirals. Materials and methods Retrospective study (2010) of HIV-infected older pts (≥65 years) monitored at the infectious disease unit of the author's hospital. Data were obtained from patient medical records, pharmacy medicines database and laboratory test results. Methods used to evaluate CVD: ▶ Framingham risk score (FRS): those whose 10-year risk of coronary heart disease-absolute risk (AR) is predicted to be >20% should be considered for treatment; ▶ Systematic Coronary Risk Evaluation (SCORE): those whose 10-year absolute risk of a fatal cardiovascular event was directly estimated at AR≥10%, if older, should be considered for treatment. Portugal is considered low risk. For female diabetic pts results are multiplied by five, for male patients by three; ▶ Atherogenic index of plasma (AIP): predictor of cardiovascular risk for pts with index >5. Results Of 63 pts (48 men), mean age 70.4 (65–84), 15 had diabetes, 4 were smokers and 23 pts presented either one or more CVD risk scales or index: FRS=16; SCORE=17; IAP=9; FRS+SCORE=10; IAP+FRS=4; IAP+SCORE=0; FRS+SCORE+IAP=5. These 23 pts were treated with at least one antiretroviral that induces hypercholesterolemia (seven showed elevated laboratory test results) and hyperglycaemia (12 had diabetes). Antiretrovirals most commonly used: tenofovir+emtricitabine (35), lopinavir+ritonavir (13), zidovudine+lamivudine (9), abacavir+lamivudine (8) and efavirenz (18). Diabetic pts, as well as those with elevated total cholesterol, presented a higher AR. Conclusions The older population studied presented an increased risk of CVD, confirmed by three evaluation methods, a fact probably also related to ART, since they all had in their therapeutic regimen, one or more medicines that increases total cholesterol and glucose.