The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) 

Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR) 

ABI
: ankle-brachial index

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2016 ESC/EAS Guidelines for the Management of Dyslipidaemias

2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR).

ESC/EAS Guidelines for the management of dyslipidaemias

Summary: The Annual Surveillance Report has been published each year since 1997. The report provides a comprehensive analysis of HIV, viral hepatitis and sexually transmissible infections in Australia and includes estimates of incidence and prevalence of HIV and viral hepatitis, by demographic and risk groups, patterns of treatment for HIV and viral hepatitis infection, and behavioural risk factors for HIV and Hepatitis C infection.

HIV, viral hepatitis and sexually transmissible infections in Australia

Background: With advances in antiretroviral therapy, most deaths in people with HIV are now attributable to noncommunicable illnesses, especially cardiovascular disease. We determine the associatio...

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Global Burden of Atherosclerotic Cardiovascular Disease in People Living With HIV: Systematic Review and Meta-Analysis.

Objectives
The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV-uninfected population.

Methods
We conducted a systematic review and meta-analysis of studies from the peer-reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV-positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART).

Results
The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43–1.81] among PLHIV without ART compared with HIV-uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV-uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment-naive PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)-, nucleoside reverse transcriptase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI-based versus non-PI-based ART was 1.41 (95% CI 1.20–1.65).

Conclusion
PLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI-based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1468-1293.2012.00996.x

Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis.

Background
Antiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity. However, other morbidities appear to be more common among PLHIV than in the general population. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV) compared to the HIV-uninfected population.

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Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

BACKGROUND In some countries, HIV surveillance is based on case-reporting of newly diagnosed infections. We present a new back-projection method for estimating HIV-incidence trends using individuals' CD4 cell counts at diagnosis. METHODS On the basis of a review of CD4 cell count distributions among HIV-uninfected people, CD4 cell count following primary infection, and rates of CD4 cell count decline over time among people with HIV, we simulate the expected distribution in time between infection and diagnosis. Applying this to all diagnosed individuals provides a distribution of likely infection times and estimates for population incidence, level of undiagnosed HIV, and the average time from infection to diagnosis each year. We applied this method to the national HIV case surveillance data of Australia for 1983-2013. RESULTS The estimated number of new HIV infections in Australia in 2013 was 912 (95% uncertainty bound 835-1002). We estimate that 2280 (95% uncertainty bound 1900-2830) people were living with undiagnosed HIV at the end of 2013, corresponding to approximately 9.4% (95% uncertainty bound 7.8-10.1%) of all people living with HIV. With increases in the average CD4 count at diagnosis, the inferred HIV testing rate has been increasing over time and the estimated mean and median times between infection and diagnosis have decreased substantially. However, the estimated mean time between infection and diagnosis is considerably greater than the median, indicating that some people remain undiagnosed for long periods. Differences were found between cases attributable to male homosexual exposure versus other cases. CONCLUSION This methodology provides a novel way of estimating population incidence by combining diagnosis dates and CD4 cell counts at diagnosis.

Inferring HIV incidence from case surveillance with CD4+ cell counts.

HIV infection is no longer the death sentence it once was. Attention in some resource-rich settings is turning to the field of ageing because of the realization that people living with HIV (PLHIV) age at greater rates than the non-HIVinfected population. It is suggested that PLHIV are more at risk for a host of comorbidities including cancers, renal failure, mental health disorders and also cardiovascular disease (CVD) [1]. We decided to collate the existing evidence and determine what the current body of knowledge indicates about the relative extent of risk of CVD for PLHIV. In doing so, we found that there was no consistency in the way that studies were designed, their data were analysed and/or their results were reported, which makes external comparison and drawing overarching conclusions difficult. The studies were also not ideally designed to address the broader research question of our review and meta-analysis. This could have been a condequence of feasibility issues within the studies or because the studies were addressing related but different questions. Despite this, we believed it was timely and important to conduct a synthesis and meta-analyses but there are factors to be acknowledged in interpreting our findings. We thank Althoff and Gange for addressing some of these factors. Firstly, we agree with Althoff and Gange that the comparison between HIV-infected and HIV-uninfected adults was not ideal. However, as they point out this was a consequence of the scarcity of data from the few studies designed in the best epidemiological manner for our purposes. The factors identified by Althoff and Gange are important in this context and it is unfortunate that underlying studies did not control for them completely. However, it is unreasonable to expect all studies to match all conceivable factors for a true control and each study to match the same factors. As a result of heterogeneities, we were unable to quantify estimates from all the studies as a whole. Rather, we had to conduct a series of meta-analyses. That does not alleviate the problem of incomparability with the full demographics and other characteristics of the setting-specific populations. As that was out of our control, we reported on pooled estimates of meta-analyses from collated relevant studies in subgroups. The outcomes from our analyses should consider these caveats, but it is not clear whether, and if so to what extent, they may bias results. Secondly, as we previously stated in discussion of our analysis, the included studies could not adjust for all confounders and our synthesis could only report on studies as they were conducted and reported. As in all epidemiological and clinical studies, exogenous factors that are believed to be associated with the dependent and independent variables should be assessed and accounted for in study analyses. We chose to include studies that met selection criteria and, although there were some inconsistencies in the chosen confounders or ignored potential confounders, each study had some merit in contributing to our knowledge of CVD among PLHIV. Althoff and Gange’s criteria uphold gold standards of epidemiological and clinical study designs; however, it is not feasible for the vast majority of studies to eliminate confounding or collect all data to adjust for all possible confounders. Yet most studies contribute valuable scientific knowledge, including those investigated in our synthesis which contributed to the overarching knowledge of CVD among PLHIV. Thirdly, it is accepted that AIDS deaths are no longer a competing factor, at least largely in the developed world. Other adjustments to standard methodologies to account for competing risks would be unlikely to lead to findings that the actual extent of CVD would have been the same in these populations had HIV not been present, especially considering the highly significant relative risks found in the studies and our analyses as well as extensive anecdotal evidence from many clinicians. Correspondence: David P. Wilson, The Kirby Institute, The University of New South Wales, Sydney, NSW 2010, Australia. Tel: +61 2 9385 0900; fax: +61 2 9385 0920; e-mail: dwilson@unsw.edu.au DOI: 10.1111/hiv.12006 © 2013 British HIV Association HIV Medicine (2013), 14, 193–194 LETTER TO THE EDITOR

A critical epidemiological review of cardiovascular disease risk in HIV-infected adults: the importance of the HIV-uninfected comparison group, confounding, and competing risks--authors' reply.

Jianyun Wu

Papers

Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta-analysis.

Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis

Inferring HIV incidence from case surveillance with CD4+ cell counts.

A critical epidemiological review of cardiovascular disease risk in HIV-infected adults: the importance of the HIV-uninfected comparison group, confounding, and competing risks--authors' reply.