The data‐collection on adverse effects of anti‐HIV drugs (D:A:D) model for predicting cardiovascular events: External validation in a diverse cohort of people living with HIV

OBJECTIVES: Little is known about the external validity of the Data‐collection on Adverse Effects of Anti‐HIV Drugs (D:A:D) model for predicting cardiovascular disease (CVD) risk among people living with HIV (PLWH). We aimed to evaluate the performance of the updated D:A:D model for 5‐year CVD risk in a diverse group of PLWH engaged in HIV care. METHODS: We used data from an institutional HIV registry, which includes PLWH engaged in care at a safety‐net HIV clinic. Eligible individuals had a baseline clinical encounter between 1 January 2013 and 31 December 2014, with follow‐up through to 31 December 2019. We estimated 5‐year predicted risks of CVD as a function of the prognostic index and baseline survival of the D:A:D model, which were used to assess model discrimination (C‐index), calibration and net benefit. RESULTS: Our evaluable population comprised 1029 PLWH, of whom 30% were female, 50% were non‐Hispanic black, and median age was 45 years. The C‐index was 0.70 [95% confidence limits (CL): 0.64–0.75]. The predicted 5‐year CVD risk was 3.0% and the observed 5‐year risk was 8.9% (expected/observed ratio = 0.33, 95% CL: 0.26–0.54). The model had a greater net benefit than treating all or treating none at a risk threshold of 10%. CONCLUSIONS: The D:A:D model was miscalibrated for CVD risk among PLWH engaged in HIV care at an urban safety‐net HIV clinic, which may be related to differences in case‐mix and baseline CVD risk. Nevertheless, the HIV D:A:D model may be useful for decisions about CVD intervention for high‐risk patients.