Background

The Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study has developed predictive risk scores for cardiovascular disease (CVD) and chronic kidney disease (CKD, defined as confirmed estimated glomerular filtration rate [eGFR] ≤ 60 ml/min/1.73 m²) events in HIV-positive people. We hypothesized that participants in D:A:D at high (>5%) predicted risk for both CVD and CKD would be at even greater risk for CVD and CKD events.

Methods and findings

We included all participants with complete risk factor (covariate) data, baseline eGFR > 60 ml/min/1.73 m², and a confirmed (>3 months apart) eGFR < 60 ml/min/1.73 m² thereafter to calculate CVD and CKD risk scores. We calculated CVD and CKD event rates by predicted 5-year CVD and CKD risk groups (≤1%, >1%–5%, >5%) and fitted Poisson models to assess whether CVD and CKD risk group effects were multiplicative. A total of 27,215 participants contributed 202,034 person-years of follow-up: 74% male, median (IQR) age 42 (36, 49) years, median (IQR) baseline year of follow-up 2005 (2004, 2008). D:A:D risk equations predicted 3,560 (13.1%) participants at high CVD risk, 4,996 (18.4%) participants at high CKD risk, and 1,585 (5.8%) participants at both high CKD and high CVD risk. CVD and CKD event rates by predicted risk group were multiplicative. Participants at high CVD risk had a 5.63-fold (95% CI 4.47, 7.09, p < 0.001) increase in CKD events compared to those at low risk; participants at high CKD risk had a 1.31-fold (95% CI 1.09, 1.56, p = 0.005) increase in CVD events compared to those at low risk. Participants’ CVD and CKD risk groups had multiplicative predictive effects, with no evidence of an interaction (p = 0.329 and p = 0.291 for CKD and CVD, respectively). The main study limitation is the difference in the ascertainment of the clinically defined CVD endpoints and the laboratory-defined CKD endpoints.

Conclusions

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. This suggests that CVD and CKD risk in HIV-positive persons should be assessed together. The results further encourage clinicians to prioritise addressing modifiable risks for CVD and CKD in HIV-positive people.

中文翻译：

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高预测的CVD和CKD风险的HIV阳性患者的心血管疾病（CVD）和慢性肾脏病（CKD）事件发生率：D：A：D观察性研究的前瞻性分析

背景

有关抗艾滋病毒药物不良事件的数据收集（D：A：D）研究已经得出了心血管疾病（CVD）和慢性肾脏疾病（CKD）的预测风险评分，定义为已确认的估计肾小球滤过率[eGFR]≤60 ml /min/1.73 m ²）在HIV阳性患者中发生的事件。我们假设，D：A：D参与者中，较高的（> 5％）预测的CVD和CKD风险将更大。

方法和发现

我们纳入了所有参与者，这些参与者均具有完整的危险因素（协变量）数据，基线eGFR> 60 ml / min / 1.73 m ²和确诊（相隔> 3个月）eGFR <60 ml / min / 1.73 m ²然后计算CVD和CKD风险评分。我们通过预测的5年CVD和CKD风险组（≤1％，> 1％–5％，> 5％）计算了CVD和CKD事件发生率，并拟合了Poisson模型来评估CVD和CKD风险组的影响是否相乘。共有27,215名参与者参与了202,034人年的随访：74％的男性，中位（IQR）年龄为42岁（36，49）岁，中位（IQR）随访的基线年为2005（2004，2008）。D：A：D风险方程式预测3,560（13.1％）位高CVD风险参与者，4,996（18.4％）位高CKD风险参与者和1,585（5.8％）位高CKD和CVD高风险参与者。预测风险组的CVD和CKD事件发生率成倍增加。具有高CVD风险的参与者患病率为5.63倍（95％CI 4.47，7.09，p <与低风险者相比，CKD事件增加0.001）；与低风险人群相比，高CKD风险人群的CVD事件增加了1.31倍（95％CI 1.09，1.56，p = 0.005）。参与者的CVD和CKD危险组具有乘法预测作用，没有相互作用的证据（CKD和CVD分别为p = 0.329和p = 0.291）。主要的研究局限性是在确定临床定义的CVD终点和实验室定义的CKD终点时存在差异。

结论

我们发现与CVD和CKD事件的预测风险均较低的人相比，CVD和CKD事件的预测风险均较高的人，与仅CVD或CKD事件的预测风险较高的人相比，CVD和CKD事件的风险较高。这表明应该同时评估HIV阳性患者的CVD和CKD风险。结果进一步鼓励临床医生优先处理HIV阳性人群中CVD和CKD的可修改风险。