🧠 Topic: HIV & Cardiovascular Risk

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⚠️ When Numbers Mislead: Rethinking Cardiovascular Risk in People Living with HIV

🧪 Study Overview

A groundbreaking study published in Lancet HIV on January 17, 2025, by researchers from Massachusetts General Hospital, has revealed key flaws in how cardiovascular risk is assessed among individuals with HIV — especially across income levels, gender, and racial groups.

🔍 Study Focus:

• Analysed data from the REPRIEVE trial
• Participants aged 40–75 years
• 3,893 individuals from 12 countries
• Evaluated two models:
  • Pooled Cohort Equations (PCE)
  • D:A:D (Data-collection on Adverse effects of anti-HIV Drugs) risk scores

📉 Key Findings

1️⃣ Risk Underestimation in High-Income Nations

• Women and Black participants faced underestimated cardiovascular risk
• Standard models failed to capture the true burden of heart disease in these subgroups

2️⃣ Risk Overestimation in LMICs

• In Low and Middle-Income Countries (LMICs), models overestimated risk for people with HIV
• This may lead to unnecessary interventions and resource misallocation

3️⃣ Need for Calibration

• Researchers adjusted PCE scores using multipliers to improve accuracy by region and demographic
• Demonstrated the importance of localised data in global health modeling

🧬 Why HIV Increases Cardiovascular Risk

People living with HIV face elevated cardiovascular risks due to:

• Chronic inflammation
• Effects of long-term antiretroviral therapy (ART)
• Lifestyle factors like smoking and stress
• Socioeconomic disparities in access to care

🌍 REPRIEVE Trial: A Global Lens

The REPRIEVE trial is the first large-scale clinical study aimed at preventing HIV-related heart disease. It highlights the urgent need for region-specific models and more inclusive research that reflects real-world patient diversity.

📊 Global Treatment Landscape

• Effective ART has dramatically improved life expectancy
• Achieving undetectable viral loads lowers the risk of many chronic diseases
• But cardiovascular risk persists, especially in underserved populations

🔬 Implications for the Future

• Existing models aren’t one-size-fits-all
• There is a critical need for customised risk scores — particularly for women, Black individuals, and populations in LMICs
• More inclusive and diverse data collection is key to equitable health care 💡

🩺 Summary

The Lancet HIV study delivers a strong message: Cardiovascular care in HIV-positive individuals needs reform. By improving risk prediction models and tailoring them to global populations, we can move toward more accurate prevention and personalised health strategies for a community that has too often been underrepresented in research.