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Comparative 10-year atherosclerotic cardiovascular disease risk in Ethiopian HIV patients on first-line versus second-line combined antiretroviral therapy

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Title: Comparative 10-year atherosclerotic cardiovascular disease risk in Ethiopian HIV patients on first-line versus second-line combined antiretroviral therapy
Authors: Balew Arega, Gashaw Solela, Tariku Fekadu, Tirhas Tadesse, Bekele Alemayehu, Amanuel Zeleke, Kidat Ayele
Source: Atheroscler Plus
Atherosclerosis Plus, Vol 61, Iss, Pp 23-28 (2025)
Publisher Information: Elsevier BV, 2025.
Publication Year: 2025
Subject Terms: ASCVD risk, RC666-701, Full Length Article, HIV, Diseases of the circulatory (Cardiovascular) system, cART, Ethiopia
Description: BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in HIV patients, but the impact of combined antiretroviral therapy regimens on its risk in Ethiopia is unclear. This study assessed the 10-year ASCVD risk in first-line versus second-line combined antiretroviral therapy and identified predictors of intermediate-to-high risk. METHODS: A comparative cross-sectional study was conducted among HIV patients on first-line and second-line combined antiretroviral therapy, randomly selected from government hospitals in Addis Ababa. A total of 340 patients were initially selected, with 331 included in the final analysis. Data were extracted from combined antiretroviral therapy registers and medical records. The 10-year atherosclerotic cardiovascular disease risk was estimated via pooled cohort risk equations. Logistic regression identified predictors of intermediate-to-high 10-year atherosclerotic cardiovascular disease risk (≥7.5 %). RESULTS: The mean age was 53.2 ± 9.1 years, and 55.9 % were male. Among the total patients, 223 (67.5 %) were on first-line combined antiretroviral therapy, and 108 (32.5 %) were on second-line therapy. The proportion of participants with an intermediate-to-high 10-year ASCVD risk was 28.7 % (95 % CI: 25.7–33.8 %), with a significantly higher prevalence observed in the second-line combined antiretroviral therapy group (36.1 %) compared to the first-line group (25.1 %) (p = 0.005). Second-line combined antiretroviral therapy (AOR = 2.3; 95 % CI: 1.23–3.22; p = 0.02), detectable viral load (AOR = 1.73; 95 % CI: 1.04–2.88; p = 0.04), alcohol use (AOR = 2.01; 95 % CI: 1.23–3.49; p = 0.01), and being divorced (AOR = 4.10; 95 % CI: 3.14–9.66; p = 0.001) or widowed (AOR = 6.64; 95 % CI: 3.69–11.59; p = 0.02) were significantly associated with intermediate-to-high 10-year ASCVD risk. CONCLUSION: Second-line antiretroviral therapy and modifiable risk factors were associated with significantly higher 10-year ASCVD risk. Routine screening and lipid management should be integrated into HIV care, particularly for patients on second-line therapy.
Document Type: Article
Other literature type
Language: English
ISSN: 2667-0895
DOI: 10.1016/j.athplu.2025.06.002
Access URL: https://doaj.org/article/be7c5003df0249be8e01156caa934ac1
Rights: CC BY NC ND
Accession Number: edsair.doi.dedup.....907331082cd803444c6f817f1fba4e5a
Database: OpenAIRE
Description
Abstract:BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality in HIV patients, but the impact of combined antiretroviral therapy regimens on its risk in Ethiopia is unclear. This study assessed the 10-year ASCVD risk in first-line versus second-line combined antiretroviral therapy and identified predictors of intermediate-to-high risk. METHODS: A comparative cross-sectional study was conducted among HIV patients on first-line and second-line combined antiretroviral therapy, randomly selected from government hospitals in Addis Ababa. A total of 340 patients were initially selected, with 331 included in the final analysis. Data were extracted from combined antiretroviral therapy registers and medical records. The 10-year atherosclerotic cardiovascular disease risk was estimated via pooled cohort risk equations. Logistic regression identified predictors of intermediate-to-high 10-year atherosclerotic cardiovascular disease risk (≥7.5 %). RESULTS: The mean age was 53.2 ± 9.1 years, and 55.9 % were male. Among the total patients, 223 (67.5 %) were on first-line combined antiretroviral therapy, and 108 (32.5 %) were on second-line therapy. The proportion of participants with an intermediate-to-high 10-year ASCVD risk was 28.7 % (95 % CI: 25.7–33.8 %), with a significantly higher prevalence observed in the second-line combined antiretroviral therapy group (36.1 %) compared to the first-line group (25.1 %) (p = 0.005). Second-line combined antiretroviral therapy (AOR = 2.3; 95 % CI: 1.23–3.22; p = 0.02), detectable viral load (AOR = 1.73; 95 % CI: 1.04–2.88; p = 0.04), alcohol use (AOR = 2.01; 95 % CI: 1.23–3.49; p = 0.01), and being divorced (AOR = 4.10; 95 % CI: 3.14–9.66; p = 0.001) or widowed (AOR = 6.64; 95 % CI: 3.69–11.59; p = 0.02) were significantly associated with intermediate-to-high 10-year ASCVD risk. CONCLUSION: Second-line antiretroviral therapy and modifiable risk factors were associated with significantly higher 10-year ASCVD risk. Routine screening and lipid management should be integrated into HIV care, particularly for patients on second-line therapy.
ISSN:26670895
DOI:10.1016/j.athplu.2025.06.002