| Objectives To assess the risk of cardiovascular diseases(CVD)in HIV/AIDS patients,The risk factors of CVD in HIV/AIDS patients were analyzed to provide reference for the prevention and management of CVD,as well as further prolonging the life span of HIV/AIDS patients and improving the quality of life of HIV/AIDS patients.Methods Use cross-sectional survey to collect the age of patients who were followed up in the antiviral therapy clinic of Yunnan Infectious Disease Hospital from April 2022 to June 2022.Basic information,smoking status of CVD and HIV-related factors were obtained from 535 HIV/AIDS patients aged 18 years.The Prediction for ASCVD Risk in China(China-PAR)model was used to estimate the risk of CVD in the included patients.A cross-sectional analysis of the 10-year risk stratification of CVDin HIV/AIDS patients assessed by Framingham model and China-PAR model was conducted to evaluate the consistency level of the two models in predicting the 10-year risk of CVD in HIV/AIDS patients.Results 1.A total of 535 patients were included in this study,including 350 males(65.4%)and 185 females(34.6%),aged from 18 to 83 years,with an average age of(45.0±12.3)years.76 patients(14.2%)had a family history of CVD,and 57 patients(10.6%)had a history of hypertension.The overweight rate was 22.5%,smoking rate was 50.3%,male HIV/AIDS smoking rate was 61.3%,which was significantly higher than female smoking rate(29.6%).326 cases with dyslipidemia were detected,the detection rate of dyslipidemia was 60.9%.Among them,207 cases(38.7%)had decreased HDL-C,194 cases(36.3%)had increased TG,91 cases(17.0%)had increased total cholesterol,and 15 cases(2.8%)had increased LDL-C.Among 326 patients with dyslipidemia,227(69.6%)were males and 99(30.4%)were females.The prevalence rate was 65.0%in males and 53.2%in females.The prevalence of dyslipidemia in rural residents was 63.6%,higher than that in urban residents(60.8%),and the differences were statistically significant(P<0.05).The awareness rate of diabetes was 50.0%,and the treatment rate of hypoglycemic drugs was 40.6%.The rate of awareness of hyperlipidemia was 39.3%,and the rate of treatment with lipid-lowering drugs was 17.5%.2.In this study,the baseline ART regimen for HIV/AIDS patients was mainly 3TC+EFV+TDF,accounting for 33.8%,followed by EFV+3TC+AZT,accounting for 22.6%,and NVP+3TC+AZT,accounting for 13.5%.At present,3TC+EFV+TDF was the main treatment regimen(36.5%),followed by 3TC/DTG(8.5%)and 3TC+TDF+LPV/r(8.1%).Baseline CD4 cell count<200/μL accounted for the highest proportion(37.4%),baseline CD4 cell count≥350/μL accounted for 31.4%.In the latest follow-up,CD4 cell count≥350/μL accounted for the highest proportion(82.8%).In 468 patients,the most recent HIV RNA<20 copies/mL,accounting for 87.5%(468/535).3.The China-PAR model was used to assess the risk of CVD.With the increase of age,the proportion of 10-year CVD risk≥10%in HIV/AIDS patients gradually increased,and the difference was statistically significant(P<0.01).The proportion of married HIV/AIDS patients with 10-year CVD risk≥10%was higher,and the difference was statistically significant(P<0.01).The proportion of 10-year CVD risk≥10%in HIV/AIDS patients with fasting blood glucose ≥7.0mmol/L,CD4+T lymphocyte count<350/μL and total cholesterol≥6.2mmol/L was higher,and the difference was statistically significant(P<0.01 for all).The proportion of 10-year CVD risk≥10%in HIV/AIDS patients with HIV RNA load≥1000 copies/mL,triglyceride≥2.3mmol/L and LDL cholesterol≥4.1mmol/L was higher,and the difference was statistically significant(all P<0.05).Multivariate logistic regression analysis showed that male,age≥60 years old,HIV RNA≥1000 copies/mL,total cholesterol≥6.2mmol/L,fasting blood glucose ≥7.0mmol/L,LDL cholesterol≥4.1mmol/L were risk factors for CVD risk of HIV/AIDS patients≥10%in 10 years(P<0.05,P<0.01).The Framingham model was used to assess CVD risk in male,married,age≥60 years,fasting blood glucose≥7.0mmol/L,smoking,total cholesterol≥6.2mmol/L,HIV RNA load≥1000 copies/mL,and LDL cholesterol≥4.1mmol/L for 10 years The proportion of CVD risk assessment≥20%was higher,and the differences were statistically significant(P<0.01,P<0.05).Statistically significant variables in the above univariate analysis were incorporated into the multivariate logistic regression model,and the obtained analysis results showed that Age≥60 years old,male,smoking,HIV RNA≥1000 copies/mL,fasting blood glucose ≥7.0mmol/L,LDL cholesterol≥4.1mmol/L,total cholesterol≥6.2mmol/L are Framingham model assessment of HIV/AIDS Risk factors for patients with 10-year CVD risk≥20%(P<0.05,P<0.01).4.Cross-analysis of the 10-year risk stratification of CVDassessed by Framingham model and China-PAR model showed that 74.7%(351/470)of HIV/AIDS patients were classified into the same risk stratification,with a Kappa value of 0.427 and a U value of 14.193 for consistency test.The P value was<0.001,and the difference was statistically significant at the 0.05 level,suggesting that the China-PAR model and Framingham model had a moderate degree of consistency in the results of the 10-year risk assessment of CVD.After gender stratification,66.5%of male patients were classified into the same risk rating group by the China-PAR model and the Framingham model.Compared with the 10-year risk of CVDassessed by the China-PAR model,32.1%of male HIV/AIDS patients were classified as having a higher risk stratification by the Framingham model.In male HIV/AIDS patients,the Kappa value of the consistency test of the two prediction methods was 0.413,the U value was 10.241,and the P value was<0.001,suggesting China-PAR The consistency between the model and Framingham model for the 10-year risk assessment results of CVDin male HIV/AIDS patients is general.88.1%of female HIV/AIDS patients were classified into the same risk rating group by the China-PAR model and the Framingham model.Compared with the 10-year risk of CVDassessed by the China-PAR model,10.7%of women with HIV/AIDS were classified as having a higher risk stratification by the Framingham model.In female HIV/AIDS patients,Kappa values of 0.558,U values of 9.982 and P values of<0.001 showed that the China-PAR model and Framingham model had moderate consistency in the results of CVD 10-year risk assessment for female HIV/AIDS patients.Conclusions 1.Traditional risk factors for CVD in HIV/AIDS patients are more prominent and the prevalence rate is higher.Dyslipidemia in HIV/AIDS patients is mainly characterized by decreased HDL-C and elevated TG,so it is necessary to strengthen the intervention level of lipid management in HIV/AIDS patients.2.While some ARVs may be associated with an increased risk of CVD,the net effect of early initiation of ART on CVD risk in HIV/AIDS patients may be beneficial overall.HIV/AIDS patients≥60 years old,male,LDL cholesterol≥4.1mmol/L,total cholesterol≥6.2mmol/L,fasting blood glucose≥7.0mmol/L had a higher risk of CVD.HIV RNA≥1000 copies/mL may be associated with an increased risk of CVD in HIV/AIDS patients,and timely screening,prevention and intervention measures for relevant risk factors are required.3.There are differences between the China-PAR model and Framingham model in assessing the 10-year risk of CVD in HIV/AIDS patients.The results of Framingham model in evaluating the 10-year risk of CVD in HIV/AIDS patients are higher than those of China-PAR model.The two models agree to a moderate degree.When assessing the risk of CVD in HIV/AIDS patients,it is necessary to select an appropriate CVD risk assessment method by comprehensively considering the gender and age of assessment objects and the applicability of assessment tools. |
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