| i |
Use the Framingham equation; a risk equation developed from HIV populations is under development (see: www.cphiv.dk/tools.aspx). This assessment and the associated considerations outlined in this figure should be repeated annually in all patients under care
(see p. 32) to ensure that the various interventions are initiated in a timely way. |
| ii |
Options for ART modification include:
(1) replace PI/r with NNRTI or by another PI/r known to cause less metabolic disturbances (see p. 36);
(2) consider replacing d4T, ZDV or ABC with TDF.
|
| iii |
Of the modifiable risk factors outlined, drug treatment is reserved for certain subgroups where benefits are considered to outweigh potential harm. Of note, there is a combined benefit of various interventions in target groups identified. Per 10 mmHg reduction in systolic blood pressure, per 1 mmol/L (39 mg/dL) reduction in TC and with use of acetylsalicylic acid, each reduces risk of IHD by 20-25%; the effect is additive. Observational studies suggest that smoking cessation results in greatest reductions in risk of IHD 50% - and this is additive to other interventions. This benefit only becomes apparent up to 5 years from when intervention was first applied. |
| iv |
See discussion on drug treatment of patients with lower CVD risk at www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm. |
| v |
Target levels are to be used as guidance and are not definitive – expressed as mmol/L with mg/dL in parenthesis. In case LDL cannot be calculated because of high triglyceride levels, the non-HDL-c (TC minus
HDL-c) target should be used which is 0.8 mmol/L (30 mg/dL) higher than the corresponding LDL-c target. Target levels for TG are not listed because an independent contribution from TG to CVD risk is uncertain and hence whether this condition should be treated (see p. 49). |
| vi |
Evidence for benefit when used in persons without a history of CVD (including diabetics) is less compelling. |
