Validity of high-sensitivity C-reactive protein versus DAD equation for cardiovascular risk assessment in people living with HIV in Nigeria

Abstract

Background: Cardiovascular risk assessment is challenging in people living with HIV (PLWH). The aim of this study is to determine the validity of high-sensitivity C-reactive protein (hsCRP) compared to the Data-collection on Adverse effects of Anti-HIV Drugs (DAD) equation for cardiovascular risk prediction in PLWH in Nigeria. Methods: Using a cross-sectional study design, we systematically recruited 180 HIV-positive adults attending a tertiary hospital in Kano, Nigeria. We estimated the 5-year projected CVD risk for each participant using both the DAD equation and hsCRP. The performance of hsCRP as a new tool was then compared to the DAD equation (reference tool) by evaluating sensitivity, specificity and area under the curve (AUC) to discriminate performance. Results: The mean age (± standard deviation) of the participants was 44.03 ± 10.58 years. The predictive accuracy of hsCRP for high CVD risk showed a specificity of 88.0%, sensitivity of 77.3%, and an AUC of 0.901 (95% confidence interval, CI: 0.824–0.978, p < 0.001) with hsCRP cut-off point for high risk set at > 3.03 mg/L. Comparison between the two models showed a moderate positive correlation (r = 0.58, p < 0.001) and fair agreement (κ = 0.26, p < 0.001). No factors significantly influenced the validity of hsCRP after regression modeling. Conclusion: hsCRP is an excellent predictor of cardiovascular disease risk in PLWH, independent of traditional risk factors, comorbidities, and sociodemographic characteristics. Our findings suggest that hsCRP could be a feasible option for cardiovascular risk assessment in resource-limited settings, pending further validation in diverse populations.