BHIVA guidelines modify assessment of cardiovascular risk (2023)

1 June 2023. Related: Guidelines.

Simon Collins, HIV i-Base

On 28 May 2023, BHIVA added a short note on cardiovascular assessment to the 2022 guidelines and published this as an interim update.

The new text was added to section 8.3.1 on page 157 and is included below.

New text in 2023 interim update:

The previous advice to adjust estimated CVD risk by a factor of 1.6 for people living with HIV has been removed based on limited evidence. CVD risk assessment will be included in the next update of the BHIVA monitoring guidelines.

It is important to acknowledge that standard tools, such as QRISK, may underestimate CVD risk for some populations, including people living with HIV, as acknowledged by the NICE guidelines for estimating CVD risk [68].

We suggest assessing individuals on a case-by-case basis, considering HIV-specific CVD risk tools, and that clinical judgement should be applied when interpreting risk assessment scores [68,81].

Ref 68. National Institute for Health and Care Excellence. Cardiovascular disease: risk assessment and reduction, including lipid modification. Clinical guideline [CG181]. 2014. Available at: https://www.nice.org.uk/guidance/cg181 (accessed July 2021).

Ref 81. Healthcare Improvement Scotland. Risk estimation and the prevention of cardiovascular disease (SIGN 149). 2017. Available at: https://www.sign.ac.uk/media/1085/sign149.pdf (accessed May 2023).

Reference

BHIVA guidelines on antiretroviral treatment for adults living with HIV-1 2022 (2023 interim update). 28 May 2023.
https://www.bhiva.org/HIV-1-treatment-guidelines (download page)
https://www.bhiva.org/file/63513a1745ea9/BHIVA-guidelines-on-antiretroviral-treatment-for-adults-living-with-HIV-1-2022.pdf (direct PDF)