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

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