Cardiovascular disease prevention policy in HIV: recommendations from a modelling study

Abstract

Background

Cardiovascular disease (CVD) is expected to contribute a large non-communicable disease burden amongst HIV-positive people. We quantify the impact of prevention interventions on annual CVD burden and costs amongst HIV-positive people in The Netherlands.

Methods

We constructed an individual-based model of CVD in HIV-positive people using national ATHENA cohort data on 8,791 patients on combination antiretroviral therapy (cART). The model follows patients as they age, develop CVD (by incorporating a CVD risk equation) and start cardiovascular medication. Four prevention interventions were evaluated: (1) increasing the rate of earlier HIV diagnosis and treatment; (2) avoiding use of cART with increased CVD risk; (3) smoking cessation; (4) intensified monitoring and drug treatment of hypertension and dyslipidaemia, quantifying annual number of averted CVDs and costs.

Results

The model predicts that annual CVD incidence and costs will increase by 55% and 36% between 2015-2030. Traditional prevention interventions, i.e. smoking cessation and intensified monitoring and treatment of hypertension and dyslipidaemia, will avert the largest number of annual CVD cases (13.1% and 20.0%) compared to HIV-related interventions, i.e. earlier HIV diagnosis and treatment and avoiding cART with increased CVD risk (0.8% and 3.7%, respectively), as well as reduce cumulative CVD-related costs. Targeting high risk patients could avert the majority of events and costs.

Conclusions

Traditional CVD prevention interventions can maximize cardiovascular health and defray future costs, particularly if targeting high risk patients. Quantifying additional public health benefits, beyond CVD, is likely to provide further evidence for policy development.