A new project led by Thibaut Davy-Mendez, PhD, MSPH, at the Institute for Global Health and Infectious Diseases, funded by the Gilead Research Scholars Program, is taking aim at a longstanding gap in HIV care: accurately predicting who is at highest risk for cardiovascular disease.
Backed by a two-year award from Gilead, the study will evaluate whether adding a specialized lab marker, lipoprotein(a), to existing risk calculators can better predict heart disease among people living with HIV. The work draws on large-scale data from the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) research network and could reshape how clinicians assess and prevent cardiovascular events in this population.
“We know that the risk scores doctors use in everyday practice tend to underestimate cardiovascular risk for people with HIV,” said Davy-Mendez, assistant professor of infectious diseases and epidemiology. “Our goal is to build something that actually reflects their true risk and helps clinicians act earlier.”
The Problem: Standard Risk Scores Miss the Mark in HIV
In routine care, clinicians use cardiovascular risk scores—tools that combine a patient’s age, sex, race, lab values, and other factors—to estimate their 10-year risk of heart disease. These scores guide decisions such as whether to start cholesterol-lowering medication.
But for people living with HIV, these general-population tools frequently fall short.
“There have been several attempts to create risk scores specific to people with HIV, but nothing that’s been a major improvement over what we already use,” Davy-Mendez explained.
One of the newest tools in broad clinical use, the PREVENT equation, was designed to be more accurate for the general population, reflecting declining rates of cardiovascular disease in recent decades. Ironically, that improvement has widened the gap for people with HIV: as the equation is recalibrated downward for healthier general-population trends, it further underestimates risk in the HIV population.
“The PREVENT equation is more accurate for the general population now, but that means it’s even less aligned with the reality for people with HIV,” said Davy-Mendez. “The gap has actually grown.”
The Innovation: Bringing Lipoprotein(a) Into the Equation
Davy-Mendez is centered on lipoprotein(a)—often written as lipoprotein(a) or Lp(a)—a specialized blood marker related to cholesterol. Elevated Lp(a) has emerged as an independent marker of high cardiovascular risk in the general population.
Clinicians are increasingly using Lp(a) when they’re uncertain whether to intensify treatment. A markedly elevated level can tip the balance toward starting cholesterol-lowering medication (statins), pursuing more aggressive lipid control targets and identifying patients who may need closer cardiovascular monitoring.
Despite its growing use, Lp(a) has been minimally studied in people with HIV.
Davy-Mendez will use CNICS/CFAR data to calculate existing cardiovascular risk scores for people with HIV and develop a new risk model that incorporates lipoprotein(a) alongside traditional risk factors. The study will compare how well the Lp(a)-enhanced model predicts actual cardiovascular events versus standard tools like the PREVENT equation and PCE.
“If adding lipoprotein(a) meaningfully improves prediction, that’s a strong signal that we need HIV-specific tools and routine measurement of Lp(a) in clinical care,” said Davy-Mendez.
Ultimately, the goal is to identify patients at higher risk earlier, tailor preventive strategies, and reduce heart attacks, strokes, and related complications among people living with HIV.
About the Gilead Research Scholars Program
The Gilead Research Scholars Program supports early-stage investigators through two-year awards in key disease areas, including HIV and cancer. Unlike product-focused studies, these awards fund independent, investigator-initiated projects that can address a wide range of scientific and clinical questions—from HIV prevention to chronic disease management in people living with HIV.
This Gilead-funded study could provide more accurate cardiovascular risk prediction tools tailored to people with HIV, encourage routine measurement of lipoprotein(a) in HIV clinical care, inform treatment guidelines on statin initiation and other preventive strategies and lay the groundwork for AI-driven models that further refine risk assessment.