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

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-lin 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.