Cardiometabolic health in people with HIV: expert consensus review

Abstract

Objectives: To develop consensus data statements and clinical recommendations to provide guidance for improving cardiometabolic health outcomes in people with HIV based on the knowledge and experience of an international panel of experts.

Methods: A targeted literature review including 281 conference presentations, peer-reviewed articles, and background references on cardiometabolic health in adults with HIV published between January 2016 and April 2022 was conducted and used to develop draft consensus data statements. Using a modified Delphi method, an international panel of 16 experts convened in workshops and completed surveys to refine consensus data statements and generate clinical recommendations.

Results: Overall, 10 data statements, five data gaps and 14 clinical recommendations achieved consensus. In the data statements, the panel describes increased risk of cardiometabolic health concerns in people with HIV compared with the general population, known risk factors, and the potential impact of antiretroviral therapy. The panel also identified data gaps to inform future research in people with HIV. Finally, in the clinical recommendations, the panel emphasizes the need for a holistic approach to comprehensive care that includes regular assessment of cardiometabolic health, access to cardiometabolic health services, counselling on potential changes in weight after initiating or switching antiretroviral therapy and encouraging a healthy lifestyle to lower cardiometabolic health risk.

Conclusions: On the basis of available data and expert consensus, an international panel developed clinical recommendations to address the increased risk of cardiometabolic disorders in people with HIV to ensure appropriate cardiometabolic health management for this population.

Figure 1.

Timeline of the modified Delphi process to achieve consensus. Initially, a targeted literature review on cardiometabolic health in people with HIV was completed, which provided the foundation for initial draft consensus data statements. The expert panel evaluated the draft statements and proposed additional clinical recommendations in the first online survey and a series of small-group workshops. Revised consensus data statements and clinical recommendations were then evaluated in a second online survey and a subsequent workshop that included the complete expert panel. Two additional surveys (surveys 3 and 4) were conducted to evaluate the consensus statements. Statements were further evaluated and revised during content (poster and manuscript) development. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.

Figure 2.

Decision tree for evaluating consensus statements. Question 1 assessed whether a statement was clear (understandable) and was rated as yes or no. If any expert responded no to Question 1, the statement was revised for clarity. Question 2 assessed whether a statement should be included as currently written and was rated on a scale from 1 to 9. A statement had to receive a median rating ≥8 to be included as currently written. A third question asked whether the topic should be addressed in a consensus statement. If any expert responded that the topic should not be addressed, then the statement was excluded. If 100% of experts voted to address the topic, the statement was revised based on their feedback and resurveyed. The experts could also provide their feedback and propose new statements in response to free-form questions in each survey. ^aIf a topic was evaluated by 100% of experts to address in a consensus statement, then the topic was no longer polled. This figure appears in colour in the online version of JAC and in black and white in the print version of JAC.