AUTHOR=Yu Junwen , Liu Xiaoning , Zhu Zheng , Yang Zhongfang , He Jiamin , Zhang Lin , Lu Hongzhou 

TITLE=Prediction models for cardiovascular disease risk among people living with HIV: A systematic review and meta-analysis

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1138234

DOI=10.3389/fcvm.2023.1138234

ISSN=2297-055X

ABSTRACT=Background
HIV continues to be a major global health issue. The relative risk of cardiovascular disease (CVD) among people living with HIV (PLWH) was 2.16 compared to non-HIV-infections. However, there is no consensus on optional CVD risk models for PLWH. Therefore, we aimed to systematically summarize and compare prediction models for CVD risk among PLWH.

Methods
	Longitudinal studies that developed or validated prediction models for CVD risk among PLWH were systematically searched. Five databases were searched up to January 2022. The quality of the included articles was evaluated by using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We applied meta-analysis to pool the logit-transformed C-statistics for discrimination performance.

Results
Thirteen articles describing 17 models were included. All the included studies had a high risk of bias. In the meta-analysis, the pooled estimated C-statistic was 0.76 (95% CI: 0.72-0.81, I2 = 84.8%) for the D:A:D (2010), 0.75 (95% CI: 0.70-0.79, I2 = 82.4%) for the D:A:D (2010) 10-year risk version, 0.77 (95% CI: 0.74-0.80, I2 = 82.2%) for the full D:A:D (2016) model, 0.74 (95% CI: 0.68-0.79, I2 = 86.2%) for the reduced D:A:D (2016) model, 0.71 (95% CI: 0.61-0.79, I2 = 87.9%) for the FRS for coronary heart disease (CHD) (1998), 0.74 (95% CI: 0.70-0.78, I2 = 87.8%) for the FRS CVD model (2008), 0.72 (95% CI: 0.67-0.76, I2 = 75.0%) for the PCE, and 0.67 (95% CI: 0.56-0.77, I2 = 51.3%) for the SCORE. In the subgroup analysis, the discrimination of PCE was significantly better in the group aged ≤40 years than in the group aged 40-45 years (P=0.024) and the group aged ≥45 years (P=0.010). No models were developed or validated in Sub-Saharan Africa and the Asia region.

Conclusions
The full D:A:D (2016) model performed the best in terms of discrimination, followed by the D:A:D (2010) and PCE. However, there were no significant differences between any of the model pairings. Specific CVD risk models for older PLWH and for PLWH in Sub-Saharan Africa and the Asia region should be established.

Systematic review registration
PROSPERO CRD42022322024.