Cardiovascular Risk Prediction in Patients With Human Immunodeficiency Virus—Reply

In Reply We appreciate the interest and thoughtful comments by Raggi et al regarding our article,¹ in which we analyzed the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCEs) and a de novo human immunodeficiency virus (HIV)–specific model for predicting myocardial infarction (MI) among 19 829 HIV-infected persons in a multicenter cohort. Using rigorous methods² to evaluate model performance, we found that the PCEs performed reasonably well among white men with HIV, with calibration and discrimination generally similar to that found among uninfected cohorts. However, the PCEs performed substantially worse among white women, black men, and black women with HIV; the HIV-specific model performed even worse. In a 2016 analysis, Raggi et al³ used net reclassification improvement to evaluate 3 risk estimation models (1 of which was HIV-specific) in a single-center Italian cohort of 2550 patients with HIV. While there are several differences between the cohorts and methods used in our respective analyses, we both found that the PCEs performed modestly among persons with HIV, and models incorporating HIV-specific variables performed no better.