Clinical Scorecard: Assessment of Cardiovascular Risk Factors in Adults With HIV Acquired at Birth

At a Glance

Key Highlights

• Despite viral suppression, over half of adults with PaHIV had elevated PDAY scores predictive of increased cardiovascular risk.
• Hypertension prevalence was 9% by WHO criteria (≥140/90 mmHg) and 21% by AHA criteria (≥130/80 mmHg), with metabolic syndrome present in 3%.
• Traditional CVD risk tools may underestimate risk in young adults with PaHIV; PDAY scoring provides a more age-appropriate risk assessment.

Guideline-Based Recommendations

Diagnosis

• Use WHO (≥140/90 mmHg) and AHA (≥130/80 mmHg) blood pressure thresholds to identify hypertension in adults with PaHIV.
• Assess metabolic syndrome using standard lipid and blood pressure criteria (triglycerides ≥1.7 mmol/L, HDL <1.04 mmol/L in men and <1.29 mmol/L in women, BP ≥130/85 mmHg).
• Consider PDAY scoring to evaluate cardiovascular risk in young adults with PaHIV.

Management

• Monitor and manage modifiable cardiovascular risk factors including hypertension, dyslipidemia, and lifestyle factors.
• Recognize that statin initiation guidelines may need adaptation for adults with PaHIV due to their unique risk profile.
• Address ART-related toxicities by reviewing cumulative exposure to boosted protease inhibitors and specific NRTIs associated with increased CVD risk.

Monitoring & Follow-up

• Regularly monitor blood pressure, lipid profiles, and viral load to maintain viral suppression and detect emerging cardiovascular risks.
• Use PDAY scores periodically to track progression of atherosclerotic risk in young adults with PaHIV.

Risks

• Increased cardiovascular risk due to lifelong HIV-related inflammation and ART exposure.
• Traditional risk factors compounded by social determinants such as poverty, smoking, substance use, and mental health issues.
• Potential underestimation of CVD risk by traditional age-based risk tools.

Patient & Prescribing Data

Adults with perinatally acquired HIV aged 18–40 years, predominantly Black ethnicity, with long-term ART exposure and high rates of viral suppression.

Long duration of ART (median 19 years) with exposure to boosted protease inhibitors and certain NRTIs may increase cardiovascular risk; viral suppression does not eliminate elevated PDAY scores indicating risk.

Clinical Best Practices

• Incorporate PDAY scoring in cardiovascular risk assessment for young adults with PaHIV to better identify at-risk individuals.
• Apply both WHO and AHA hypertension criteria to capture a broader spectrum of elevated blood pressure in this population.
• Tailor cardiovascular risk management strategies considering lifelong ART exposure and social determinants impacting adults with PaHIV.

References

• World Health Organization Hypertension Guidelines
• American Heart Association Hypertension Guidelines
• PDAY Score Validation Study
• Cardiovascular Risk in Perinatally Acquired HIV
• UK PaHIV Adult Cohort Study