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.