The Role of the Framingham Risk Score to Predict the Presence of Subclinical Coronary Atherosclerosis in Patients with HIV Infection

Patients with HIV infection have an increased mortality, largely attributable to coronary artery disease (CAD),1-3 and there is increasing evidence that these patients have more extensive coronary calcification than age-matched control subjects.4,5 The assessment of the risk to develop CAD is a challenge in patients with HIV infection because there are many aspects that contribute to generate it. It is well known that smoking habit is more frequent in patients with HIV infection; however, a citotoxic direct effect on myocardial cells (mediated by HIV) and the inflammatory reaction associated with HIV infection may play a role in the atherosclerotic process. In addition, the treatment with combination antiretroviral therapy (cART), despite the positive modification of the natural history of HIV infection, is associated with a variety of metabolic abnormalities that determine an increase of CAD risk. Therefore, there is the need to stratify the risk of coronary events in HIV patients, taking into account all the components cited above.