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. 2025 Sep 26:ciaf542.
doi: 10.1093/cid/ciaf542. Online ahead of print.

Risk Assessment in a Global CVD Prevention Cohort of People with HIV by PCE, PREVENT, and SCORE2

Steven K Grinspoon  1 , Sophia Zhao  1 , Esteban Martinez  2 , Carl J Fichtenbaum  3 , Sarah M Chu  1 , Marissa R Diggs  1 , Triin Umbleja  4 , Sara McCallum  1 , Kathleen V Fitch  1 , Virginia A Triant  5 , Judith S Currier  6 , Judith A Aberg  7 , Carlos D Malvestutto  8 , Kristine M Erlandson  9 , Gerald S Bloomfield  10 , Michael T Lu  11 , Pamela S Douglas  12 , Heather J Ribaudo  4 , Markella V Zanni  1
Affiliations

Risk Assessment in a Global CVD Prevention Cohort of People with HIV by PCE, PREVENT, and SCORE2

Steven K Grinspoon et al. Clin Infect Dis. .

Abstract

Background: REPRIEVE findings catalyzed changes to multiple guidelines directing statin therapy prescribing for people with HIV (PWH). US guidelines use the Pooled Cohort Equations (PCE)-derived 10-year ASCVD risk score but may in the future incorporate the new PREVENT score. Meanwhile, European guidelines use SCORE2.

Methods: Leveraging REPRIEVE, we compared effects of applying PCE versus either PREVENT according to US guidelines or SCORE2 according to European guidelines among a global primary CVD prevention cohort of PWH.

Findings: Analysis cohort included 7,757 participants with data for PREVENT and SCORE2 calculation. 10-year ASCVD risk estimates (median [Q1, Q3]) were highest with PCE (4.4% [2.1%, 7.1%]) versus SCORE2 (3.3% [2.0%, 4.9%]) and PREVENT (2.2% [1.3%, 3.3%]). PREVENT- (vs PCE-) based scoring re-classified 38% of participants from a higher to a lower risk group (≥5% to <5%) while SCORE2-based scoring analogously shifted 27% of those age ≥50 years. Among placebo-assigned participants, median observed incidence of hard major adverse cardiovascular events (MACE)/1000 person years (PY) was higher than that predicted by PREVENT, except for those with ultra-low predicted risk. Estimated cumulative incidence of primary MACE was higher and 5-year number-needed-to-treat (NNT5) lower for most risk groups using PREVENT versus PCE. The NNT5 for the PREVENT-defined risk group of 2.5-5.0% was close to the NNT5 for the PCE-defined risk group of ≥5% (NNT5[95% CI]: 53 [31, 178] versus 47 [30, 109], respectively).

Interpretation: Statin prescribing guidelines for PWH based on REPRIEVE should account for differences in 10-year ASCVD risk estimates when scores other than PCE are used.

Funding: National Institutes of Health, Kowa Pharmaceuticals America, Gilead Sciences, ViiV Healthcare.

Trial registration: REPRIEVE; NCT02344290; https://clinicaltrials.gov/study/NCT02344290.

Keywords: HIV; REPRIEVE; atherosclerotic cardiovascular disease; risk scores; statin.

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