Study reveals underestimation of cardiovascular risk in people with HIV.

A recent international study conducted by a team from Massachusetts General Hospital has highlighted the discrepancy in cardiovascular risk models applied to people with HIV. This analysis concludes that these models underestimate the risk for key populations, particularly for Black women and men from high-income countries. The research, published in the journal 'Lancet HIV,' has pointed out the urgent need to review and update the cardiovascular disease (CVD) prediction tools used for this group. CVD represents one of the leading causes of morbidity and mortality globally, and its impact is even more significant in people infected with HIV. With the growing prevalence of cardiovascular disease in this population, current prediction models, such as atherosclerotic cardiovascular disease risk scores, have been deemed insufficient. This study is an important step toward better understanding how these models may fail to accurately identify cardiovascular risk in people with HIV across different socioeconomic contexts. The researchers used data from the REPRIEVE trial, a randomized study designed to prevent vascular events in people with HIV. Through a prospective approach that included participants from countries with varying income levels, the scientists were able to assess the applicability and accuracy of existing risk models in a more diverse and global context. This approach has allowed for the identification of current limitations and the need for models that are more sensitive to demographic and geographical differences. The results were alarming: existing models underestimated cardiovascular events in Black women and men in high-income countries, while overestimating risks in people with HIV in low- and middle-income nations. This discrepancy not only affects how treatments are approached but also endangers the health of populations that may require more aggressive and specific care. Patrice Desvigne-Nickens, a physician at the National Heart, Lung, and Blood Institute in the U.S., emphasized the importance of refining these prediction models: "Evaluating the accuracy of these predictions in subgroups is essential to improve care for people living with HIV." This statement underscores the need to tailor medical approaches to specific demographic realities, thus avoiding generalizations that can be harmful. The study's co-author, Steven Grinspoon, also stressed the importance of developing more nuanced prediction models that recognize the particularities of each region and population. This call to action is crucial to ensure that all patients receive appropriate treatment and that their risks are accurately assessed. Additionally, the study has calculated correction factors that could improve risk estimates in future assessments. However, the researchers warn that further work is needed to validate these factors in external cohorts, a critical step toward establishing more precise and reliable protocols for managing HIV and its associated complications. Markella Zanni, the study's lead co-author, hopes that these findings will be recognized by guideline committees and that more rigorous treatment recommendations will be implemented for Black women and men living with HIV in high-income countries. The inclusion of this data in recommendations could significantly change how cardiovascular health is addressed in this demographic group. The research presented not only provides a new perspective on cardiovascular risk in people with HIV but also poses a challenge for the medical community. The need for revisions and updates in treatment guidelines is evident and essential to ensure that all patients receive fair and equitable care that recognizes their specific and unique risks. Finally, this study once again underscores the importance of inclusive research in health. By considering diversity in studied populations, we can move toward a healthcare model that is not only effective but also accessible and tailored to the needs of all people living with HIV, regardless of their ethnic or socioeconomic background.