Assessing Cardiovascular Risk Using the Framingham Risk Score Among People Living with HIV on HAART at Machakos County Referral Hospital, Kenya

Abstract

The widespread availability of HAART has significantly extended the survival of people living with HIV. With this increased life expectancy, NCDs such as cardiovascular disease have emerged as major health concerns. Both HIV infection and long-term exposure to antiretroviral therapy contribute to metabolic changes and early vascular aging. This study assessed cardiovascular risk using the Framingham Risk Score (FRS) among people living with HIV (PLHIV) receiving HAART at Machakos County Referral Hospital, Kenya. It examined demographic and clinical factors associated with elevated risk. A cross-sectional study was conducted among 406 adult PLHIV who had been on HAART ≤ 3 months. Data was collected through structured questionnaires, interviews, health records review, and laboratory analyses. The 10-year CVD risk was estimated using the Adult Treatment Panel III (ATP III) Framingham algorithm, categorizing patients as low, moderate, moderately high, or high risk. Most participants (71.2%) were classified as low cardiovascular risk; 18.5% as moderate risk, 9.8% as moderately high cardiovascular risk and 0.5% as high cardiovascular risk individuals. Older age {25–40 years (AOR = 37.11, 95% CI: 10.12–140.16, p < 0.001), 41–59 years (AOR = 31.01, 95% CI: 9.04–140.16, p < 0.001), and ≥60 years (AOR = 9.75, 95% CI: 7.14–31.74, p < 0.001)}, male gender (AOR = 3.44, 95% CI: 1.67–8.09, p = 0.001), elevated HDL (AOR = 8.23, 95% CI: 3.92–17.26, p < 0.001), smoking (AOR = 6.80, 95% CI: 1.53–31.25, p < 0.001), shorter duration on antiretrovirals (<5 years) (AOR = 5.17, 95% CI: 1.94–13.79, p = 0.001), and systolic BP ≥140 mmHg (AOR = 30.16, 95% CI: 12.43 73.18, p < 0.001) were significantly associated with higher CVD risk. Thus, although most PLHIV on HAART at Machakos County Referral Hospital had low cardiovascular risk, older age, male gender, hypertension, smoking, short duration on antiretrovirals, and dyslipidemia were found to be key contributors to elevated FRS. These findings underscore the need to integrate routine cardiovascular risk screening and lifestyle modification interventions into HIV care programs in Kenya.