Magnitude of Cardiovascular Diseases and Associated Factors of among Human Immune Deficiency Positive Patients on Ant- Retroviral Therapy in Ethiopia: Multicenter Cross-Sectional Study

Magnitude of Cardiovascular Diseases and Associated Factors of among Human Immune Deficiency Positive Patients on Ant- Retroviral Therapy in Ethiopia: Multicenter Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Magnitude of Cardiovascular Diseases and Associated Factors of among Human Immune Deficiency Positive Patients on Ant- Retroviral Therapy in Ethiopia: Multicenter Cross-Sectional Study Tagese Yakob Barata, Saba Fentaye, Begidu Yakob, Awoke Abraham, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4571158/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Cardiovascular disease (CVD) has been identified as the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLHIV). Therefore, it is important to determine the risk of cardiovascular disease (CVD) from multiple centers. Objective This study aimed to determine the burden and associated factors of cardiovascular disease among HIV-positive patients on antiretroviral therapy (ART) in hospitals in Ethiopia. Method This was an institutionally based cross-sectional study of 409 adult HIV-infected patients who were receiving ART for at least six months from February 1–30, 2023. A systematic random sampling technique was employed to select the study participants, and the data were collected through face-to-face interviews using a structured questionnaire. The data were cleaned, coded, and entered into Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. For descriptive statistics, both bivariate and multivariable logistic regression analyses were employed. Variables with a P value < 0.05 in the multivariable logistic regression analysis were considered determinant factors for cardiovascular disease among HIV-infected patients. Results A total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. The prevalence of cardiovascular diseases among adult HIV-positive patients was 70 (17.5%) (95% CI, 14.10-21.61). An undergraduate education level of patients living with HIV/ADIS (AOR = 0.21, 95% CI: (0.48–0.97)), a family history of cardiovascular disease (AOR = 2.02, 95% CI: (1.12–3.66), duration of ART treatment (AOR = 4.38, 95% CI: (1.36–14.10), and living with HIV/ADIS with triglycerides (mg/dl) > 150 (AOR = 2.84, 95% CI: (1.06–7.64) independently predicted cardiovascular disease among HIV/ADIS patients. Conclusion The magnitude of CVD incidence was high in this study. Educational status, family history of cardiovascular disease, duration of ART, and triglyceride concentration > 150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. To increase early detection and early care, HIV care services need to integrate NCDs in both service areas, which has been recommended as a solution to decrease the burden of CVD. Health sciences/Cardiology Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Prevalence cardiovascular diseases risk factors HIV HAART Figures Figure 1 Figure 2 Background Cardiovascular diseases (CVDs) have been identified as the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLHIV)( 1 ). The improved survival rate of PLHIV and changing HIV disease patterns have resulted in a growing burden of multi-morbidity ( 2 ). Crucially, the changing landscape of HIV clinical care, as recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risks. Globally, at least 84% of PLHIV are diagnosed with one non-communicable disease (NCD) by 2030 ( 3 ). It is the leading cause of death globally (31%) and in Africa (11.3%)( 4 ). Among patients with heart disease, up to 9.7% are infected with HIV ( 5 ). All heart structures are involved, the severity of which correlates with that of immune deficiency ( 6 ). PLWH are at increased risk for CVD ( 7 , 8 ), and access to ART has expanded; additionally, more PLWH are living past 50 years of age ( 9 ) and facing an increased risk of CVD due to traditional CVD risk factors alone ( 9 ). HIV infection and the metabolic effects associated with ART increase the burden of cardiovascular disease in low-income countries ( 10 ). In the context of the increasing availability of ART for patients even at the early stage of HIV infection, as deaths due to HIV-associated opportunistic infections are decreasing, increased rates of mortality due to HIV-associated cardiovascular disease are expected among HIV-infected adults ( 10 ). With the demographic and epidemiological transition from infectious diseases to NCDs in Sub-Saharan Africa (SSA), there is a growing burden of CVD due to, among other factors, rapid urbanization, economic changes, and concomitant nutrition transitions ( 11 ). The increased risk has been linked to traditional CVD risk factors, HIV infection itself, antiretroviral regimens, and the immunological dynamics that originate from the infection ( 12 , 13 ). A systematic review and meta-analysis among HIV-infected populations in SSA countries indicated a strong association between the use of antiretroviral therapy (ART) and mortality due to CVD ( 14 ). This is attributed to the aging population of people living with HIV, ART, HIV-related inflammation, and traditional lifestyle risk factors such as smoking, alcohol intake, and inactivity ( 12 , 15 , 16 ). Studies on the association between cardiovascular risk factors and HIV are mainly from developed countries, yet SSA accounts for 67% of the global burden of HIV ( 17 ). Analyzing the distribution of cardiovascular risk factors among persons living with HIV in SSA is important due to the known cardiovascular effects of HIV and the high prevalence of HIV ( 18 ). As a result of the success and scale-up of ART over the past fifteen years, HIV has become a chronic disease with increased life expectancy and aging among patients in SSA countries, including Ethiopia ( 18 ). The use of highly active antiretroviral therapy (HAART) has been linked to hyperglycemia, dyslipidemia, and increased risk of CVD in HIV-infected patients ( 19 ). However, epidemiological data on cardiovascular disease in HIV-infected individuals are still scarce, and due to different occasions, attention to HIV/AIDS has been neglected; moreover, the burden of CVD risk factors among HIV patients has not been well studied ( 19 ), and studies using a representative sample are particularly scarce in Ethiopia. Therefore, this study aimed to assess the magnitude and associated factors of cardiovascular diseases among HIV-positive patients on ART in governmental hospitals in Addis Ababa, Ethiopia. METHODS AND MATERIALS Study area, study period, and design The study was conducted in Addis Ababa, Ethiopia. Addis Ababa, the capital city of the Federal Democratic Republic of Ethiopia, is located at the center of the country. The city has 11 sub-cities and 116 Woredas. There are 13 governmental hospitals in Addis Ababa, of which 6 are administered by the Addis Ababa City Organization Health Bureau, 4 by the Federal Ministry of Health (FoMH), 1 by Addis Ababa University, and 3 by Defense Constraint and Police. The hospitals were selected by the lottery method. Hence, Tikur Anbessa Specialized Hospital, St. Peter Specialized Hospital, Alert Hospital and Minillik II Hospital were selected for the current study. Tikur Anbessa Specialized Hospital is the largest referral and teaching hospital in Ethiopia and is operated by the Ministry of Education of Ethiopia. Minillik II Hospital is managed by the Addis Ababa Administrative Health Office. St. Peter’s specialized hospital is also another referral hospital that is administered under the Federal Ministry of Health. The duration of the study ranged from February to March 2023. An institution-based cross-sectional study was conducted among patients with HIV on ART at selected governmental hospitals in Addis Ababa. Population The source population was all HIV-infected patients who underwent ART follow-up at governmental hospitals in Addis Ababa, and the study populations were all HIV-infected adult patients aged ≥ 18 years receiving HIV care and who received ART follow-up at selected governmental hospitals in Addis Ababa. All adults aged ≥ 18 years and HIV-infected patients with HAART attending selected governmental hospitals in Addis Ababa for more than six months and those who were willing to participate in the study included were pregnant and lactating women, and those with documented hypertension, diabetes, or dyslipidemia before starting HAART were excluded from the study. Sample size determination The sample size was determined using a single population proportion formula by taking 41.3% of the incidence of cardiovascular diseases among HIV-infected adults from a similar study in Debre Markos Referral Hospital, Northwest Ethiopia ( 20 ). Considering the following assumptions, z = standard normal distribution value at a 95% confidence level of zα/2 = 1.96 and margin of error (d) = 5%. The calculated sample size was 372, and by adding a 10% nonresponse rate, the final sample size was 409. Sampling technique A systematic random sampling technique was used to identify the study subjects and 600 adult HIV-infected patients who were receiving ART at Tikur Anbessa Specialized Hospital, 700 at Minillik II Hospital, 250 at St, Petros Hospital, and 300 at Alert Hospital ART clinics for an average of one month. The sampling interval was calculated by using the formula k = N/n, which is 1850/409, K = 4.52≈5, and the initial sample was selected using the lottery method. Therefore, every 5th patient who attended ART clinics was enrolled in the study until the calculated sample size was achieved within the length of the data collection period (Fig. 1). Study variables The burden of cardiovascular disease was the dependent variable, and the socio-demographic factors included age, sex, marital status, sex, educational level, occupation status, and income; the clinical and biochemical characteristics included blood pressure, body mass index, CD4 cell count, and fasting blood sugar; and the lifestyle factors included a history of alcohol intake, salt intake, fruit and vegetable intake, and walking/day, which were some of the independent variables of the study. Operational Definition and Preferred Cutoff Values Hypertension was defined as a systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. An abnormal lipid profile was defined as TC ≥ 200 mg/dl, HDL-c < 40 mg/dl, LDL-c ≥ 130 mg/dl, TG ≥ 150 mg/dl, and a TC/HDL-c ratio ≥ 5 ( 21 ). Cardiovascular diseases are defined as having at least one of the following: chronic rheumatic heart disease; hypertension; hypertensive heart disease; ischemic heart disease; or other heart diseases, such as cardiomyopathies, arrhythmias, or valvular heart diseases ( 22 ). The outcome variable (cardiovascular disease) was measured by yes/no questions. Data collection tools and procedures The data were collected by using a pretested, structured, and interviewer-administered questionnaire adapted from the literature reviews. The tool was validated by the World Health Organization and adapted to the Ethiopian context. A structured questionnaire and patient chart were used to collect data on the socio-demographic characteristics; patients’ records were reviewed to obtain information on their current CD4 + T-cell count and HIV and HAART status. A thorough physical examination was performed, including measurements of blood pressure and anthropometric variables. Height was measured with a meter ruler with the patients standing erect on a flat surface without shoes. Weight was recorded in kilograms using a standard weighing scale on a firm horizontal surface with patients wearing light clothing. Hypertension is diagnosed if the patient has a record of systolic blood pressure readings ≥ 140 mmHg and/or if the diastolic blood pressure readings on both days are ≥ 90 mmHg on two different days( 23 ). Obesity was defined as a BMI ≥ 30.0 kg/m 2 . Lipid profiles were assessed through enzymatic methods (INMESCO, GmbH (L-S 04/2009)) for all participants and included total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c) and triglyceride (TG) levels taken from patient charts. The data collectors were four senior BSc nurses and two laboratory technicians who had experience in data collection procedures. The investigator supervised the daily activities. To ensure consistency, the English version of the questionnaire was translated into the local language Amharic and returned to English. Data quality control To maintain data quality, training was given to the data collectors. The supervisor/principal investigator supervised the data collectors on a daily basis for the completeness and consistency of the completed questionnaires. Additionally, the data were thoroughly cleaned and carefully entered into a computer at the beginning of the analysis. Pretests were performed on 5% of the study subjects outside of the study setting. The investigators and data collectors took part in a pretest of the survey questionnaire among the study subjects. Data Analysis and Interpretation After checking for completeness and consistency of the collected information, the data were cleaned, coded, entered into Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. The descriptive statistics (means, standard deviations, percentages, or frequencies) were calculated, and bivariate logistic regression analyses were used to determine the relationships between the dependent and independent variables. Variables with a p value of 0.25 in the bivariate analysis were considered to be associated with the dependent variable and were entered into the multivariate analysis. The strength of the association was measured using an odds ratio and interpreted by considering the 95% confidence interval and p value of 0.05 as statistically significant risk factors in multivariate analysis. Finally, the results were presented using texts, charts, and tables. Results Demographics and Clinical Characteristics A total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. Of these, 260 (51.6%) were male. The mean age (SD) of the study participants was 43 (11.2) years, with the youngest participant being 20 years old and the oldest being 74 years old. More than half of the patients (268, 67.2%) were married, approximately 221 (55.4%) were government employees, and approximately 158 (39.5%) had a school-level education. Half of the 200 participants (50.15%) had a monthly income of 2501–5000 ETB, and approximately 147 (36.8%) had a family history of cardiovascular disease. The mean duration of diagnosis of HIV/ADIS was 12 (± 5.1 SD) years, and the mean duration of ART use was 12 (± 5.8 SD) years. (Table 1 ) Table 1 Socio-demographic characteristics of the burden of CVD among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n = 399). Variables(n = 399) Category CVD (%) p value Yes No Age category (Years) 18–29 4(8.7) 43(91.3) 0.002 30–39 5(6.0) 78(94.0) 40–49 27(19.8) 109(80.2) 50–59 25(26.6) 69(73.4) 60+ 9(23.1) 30(76.1) Sex Male 40(19.4) 166(80.6) 0.229 Female 30(15.5) 163(84.5) Marital status Unmarried 28(21.8) 100(78.2) 0.309 Married 42(15.7) 226(84.3) Divorced 0(0) 3(100) Occupational status Housewife 14(29.8) 33(70.2) 0.083 Government Employee 36(16.3) 185(83.7) Private employee 6(11.2) 48(88.8) Unemployed 14(18.2) 63(81.8) Educational status Never attended school 6(33.4) 12(66.6) 0.002 School level 21(13.3) 137(86.7) Certificate level 35(25.2) 104(74.8) Undergraduate and above level 8(9.5) 76(90.5) Monthly income (ETB) 5001 15(16.3) 77(83.7) Duration of HIV/ADIS diagnosis time Less 10 years 20(12.1) 145(87.9) < 0.001 11–20 years 39(18.7) 171(81.3) Greater than 20years 11(42.3) 13(57.7) Duration of treatment on ART 11years 50(21.4) 184(78.6) Family history of cardiovascular disease Yes 36(24.2) 113(75.8) 0.025 No 34(13.6) 216(86.4) Lifestyle-related factors More than half (272, 68.2%) of the study participants acquired HIV through the heterosexual route (186, 55.4%). Nearly half of the patients (n = 175, 43.7%) had a history of alcohol consumption in their lifetime, and approximately 32 (8%) had a history of smoking. Only 7.8% of the patients met the WHO recommendations of consuming five or more servings of fruit and vegetables per day; approximately one-third of the 266 (66.7%) patients had a history of moderate salt intake, and approximately half of the 197 (49.4) patients had a 30- to 60-minute total walking period per day (Table 2 ). Table 2 Lifestyle-related factors of CVD among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023. Variables Category CVD (%) P value Yes No Mode HIV transmission Heterosexual route 50(18.4) 222(81.6) 0.152 Injecting drug use 18(14.6) 105(85.4) Unknown 2(50.0) 2(50.0) History of alcohol drink Yes 26(14.8) 149(85.2) 0.212 No 44(19.6) 180(80.4) History of smoke cigarettes Yes 4(12.5) 28(87.5) 0.434 No 66(18.0) 301(82.0) Fruit & vegetable consumption/day 5 portions/day 4(12.9) 27(87.1) Salt intake High 10(26.3) 28(73.7) 0.197 Moderate 41(15.4) 225(84.5) Low 19(20.0) 76(80.0) History of total walking period per day Less than 30 minutes 27(19.6) 111(80.4) 0.667 from 30–60 minutes 32(16.2) 165(83.8) from 1–2 hours 6(13.9) 37(86.1) Greater than 2 hours 5(23.8) 16(76.2) Anthropometric and biochemical characteristics of the patients Among the participants, the majority (82.2%) had a normal BMI, and only 5% of the patients were overweight. Participants were asked about their intake of alcohol, and 7 participants (2.1%) consumed alcohol in the last month. Participants were asked if they had ever been told to have increased blood glucose or diabetes, and 25 (6.3%) had increased blood glucose. Cholesterols were detected, and among the participants, 77 (19.3%) had a total cholesterol > 200 (mg/dl), 27 (6.35) had a triglyceride > 150 (mg/dl), 174 (44.1%) had an HDL-cholesterol 130 (mg/dl). For nearly half (47.9%) of the participants, the CD4 count was > 500, and the mean systolic and diastolic pressures were 116.4 ± 15 (SD) and 73.7 ± 9 (SD), respectively (Table 3 ). Table 3 Anthropometric and biochemical characteristics of HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n = 399). Variables(n = 399) Category CVD (%) p value Yes No BMI (kg/m2) Underweight 5(9.8) 46(90.2) < 0.001 Normal 55(16.7) 273(83.2) Overweight 10(50.0) 10(50.0) Low-density lipoprotein- cholesterol < 130 (mg/dl) 38(13.2) 248(86.7) < 0.001 ≥ 130 (mg/dl) 32(50.0) 32(50.0) Total cholesterol (mg/dl) < 200 (mg/dl) 47(14.6) 275(85.4) 0.002 ≥ 200 (mg/dl) 23(50.0) 23(50.0) High-density lipoprotein-cholesterol < 40 (mg/dl) 39(22.1) 137(77.9) 0.031 ≥ 40 (mg/dl) 31(13.9) 192(86.1) Triglyceride (mg/dl) < 150 (mg/dl) 59(16.3) 313(83.7) 0.001 ≥ 150 (mg/dl) 11(40.7) 16(59.3) Fasting blood glucose (mg/dl) < 126 66(17.6) 308(82.4) 0.834 ≥ 126 4(16.0) 21(84.0) CD4 Count 500 39(20.4) 152(79.6) Mean DBP Systolic blood pressure(± SD) (mmHg) 116.4 ± 15 Mean Diastolic blood pressure(± SD) (mmHg) 73.7 ± 9 Burden of cardiovascular diseases among HIV-positive patients The prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61) ( Fig. 2 ). Among the patients with cardiovascular diseases, 50 (12.5%) had hypertensive disease, 10 (3.8%) had rheumatic heart disease (RHD), 7 (1.85%) had ischemic heart disease, and 10 (2.5%) had other diseases (cardiomyopathies, arrhythmias, valvular heart diseases) (Table 4 ). Table 4 Etiology of cardiovascular diseases among HIV-positive patients among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n = 399). Variables(n = 334) Category Frequency Percent (%) Hypertensive disease Yes 50 12.5 No 349 87.47 Ischemic heart disease Yes 7 1.8 no 392 98.2 Chronic rheumatic heart disease Yes 15 3.8 No 384 96.2 Hypertensive heart disease Yes 3 0.8 No 396 99.2 Other(cardiomyopathies, arrhythmias, Valvular heart diseases) yes 10 2.5 no 389 97.5 Factors associated with cardiovascular diseases among HIV-positive patients The candidate variables included in the bivariate analysis for multiple variables were age, educational status, family history of CVD, duration of ART treatment, and triglyceride concentration > 150 mg/dl, and mode of HIV transmission was associated with CVD among HIV-positive patients (p 150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. The model was fit with the Hosmer and Lemeshow test (p value = 0.132, x 2 = 12.8). Among patients living with HIV/ADIS, those with an undergraduate education level who were living with HIV/ADIS were 79% less likely to develop cardiovascular disease (AOR = 0.21, 95% CI: (0.48–0.97)) than were those with no formal education level. Among PLWH, those with a family history of cardiovascular disease were 2.02 times more likely to develop cardiovascular disease (AOR = 2.02, 95% CI: (1.12–3.66)). Individuals who were receiving ART for more than 20 years were 4.38 times more likely to develop cardiovascular disease (AOR = 4.38, 95% CI: (1.36–14.10)) than were those who were not receiving ART. Patients living with HIV/ADIS with triglycerides (mg/dl) > 150 were 2.84 times more likely to develop cardiovascular disease (AOR = 2.84, 95% CI: (1.06–7.64)) than patients living with HIV/ADIS with triglycerides (mg/dl) < 150 ( see Table 5 ). Table 5 Binary logistic regression analysis for the burden of cardiovascular diseases among HIV-positive patients among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n = 399) Variables Category Cardiovascular diseases (%) COR (95% CI) AOR (95% CI) p value Yes No Age category(years) 18–29 30–39 40–49 50–59 50+ 4(8.7) 43(91.3) 0.31(0.08–1.10) 0.47(0.11–1.97) 0.308 5(6.0) 78(94.0) 0.21(0.06–0.68) 0.33(0.09–1.27) 0.109 27(19.8) 109(80.2) 0.82(0.35–1.94) 1.06(0.39–2.85) 0.905 25(26.6) 69(73.4) 1.20(0.50–2.89) 1.02(0.38–2.56) 0.963 9(23.1) 30(76.1) 1(reference) 1(reference) Educational level No formal education School level Certificate level Undergraduate level 6(33.4) 12(66.6) 1(reference) 1(reference 21(13.3) 137(86.7) 4.750(1.40–16.1) 0.43(0.11–1.67) 0.793 35(25.2) 104(74.8) 1.45(0.61–3.14) 0.86(0.21–3.18) 0.793 8(9.5) 76(90.5) 0.19(1.40–7.28) 0.21(0.48–0.97) 0.046 Mode of HIV transmission Heterosexual route Injecting drug use Unknown 50(18.4) 222(81.6) 0.22(0.31–1.63) 0.13(0.21–1.67) 0.120 18(14.6) 105(85.4) 0.76(0.23–1.29) 0.21(0.11–2.57) 0.222 2(50.0) 2(50.0) 1(reference) 1(reference) Family history of cardiovascular disease Yes No 36(24.2) 113(75.8) 1.80(107 − 3.04) 2.02(1.12–3.66) 0.019 34(13.6) 216(86.4) 1(reference) 1(reference) Triglyceride (mg/dl) < 150 (mg/dl) ≥ 150 (mg/dl) 59(16.3) 313(83.7) 3.64(1.618.25) 2.84(1.06–7.64) 0.037 11(40.7) 16(59.3) 1 (reference) 1(reference) Duration of HIV/ADIS diagnosis time 20years 20(12.1) 145(87.9) 1 (reference) 1(reference) 39(18.7) 171(81.3) 1.65 (0.92–2.96) 1.30(0.68–2.51) 0.419 11(42.3) 13(57.7) 6.13(2.42–15.53) 4.38(1.36–14.1) 0.013 DISCUSSION A total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. The prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61). The candidate variables included in the bivariate analysis for multiple variables were age, educational status, family history of cardiovascular disease, duration of ART treatment, and triglyceride concentration > 150 mg/dl, and mode of HIV transmission was associated with cardiovascular disease among HIV-positive patients (p 150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. The model was fit with the Hosmer and Lemeshow test (p value = 0.132, x 2 = 12.8). The prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61). This systematic study was conducted in the Asia-Pacific region among PLHIV, and the incidence of CVD ranged from 10 to 28% ( 24 ). This percentage is lower than that reported in studies conducted in Cameroon ( 25 ) and in Northwest Ethiopia (41.3%) ( 20 ). This might be because HIV management may differ across regions, especially between high- and low- to middle-income countries. Among patients living with HIV/ADIS, those with an undergraduate education level who were living with HIV/ADIS were 79% less likely to develop cardiovascular disease (AOR = 0.21, 95% CI: (0.48–0.97)) than were those with no formal education level. This might be due to educated people living with regularly visiting hospitals and attending health education sessions to improve healthy lifestyles to reduce the risk of NCDs ( 26 , 27 ). Among PLWH, those with a family history of cardiovascular disease were 2.02 times more likely to develop cardiovascular disease (AOR = 2.02, 95% CI: (1.12–3.66)). This finding is consistent with a study conducted in an Asia-Pacific family with a steep increase in the risk for CVD( 24 ). This might be due to HIV-specific risk factors for CVD and synergistic effects between traditional and HIV-specific risk factors in the population. Individuals who were receiving ART for more than 20 years were 4.38 times more likely to develop cardiovascular disease (AOR = 4.38, 95% CI: (1.36–14.10)) than were those who were not receiving ART. This finding is consistent with a study conducted in Uganda showing that the duration of antiretroviral therapy (ART) has a significant influence on the viral load and consequently leads to CVD ( 28 ). This could be because the more advanced the patient is to ART, the greater the magnitude of the potential precursor and the greater the risk of having different comorbidities. Patients living with HIV/ADIS with triglycerides (mg/dl) > 150 mg/dl were 2.84 times more likely to develop cardiovascular disease than patients living with HIV/ADIS with triglycerides < 150 mg/dl. This study aligns with a previous study ( 29 ) in which sub-Saharan Saharan treatment was associated with increased lipid levels in sub-Saharan Africa ( 30 ) and increased CVD risk in the Asia-Pacific region ( 24 ). This could be due to lipid profile-related factors’ major roles in increasing oxidative stress in the cardiovascular system and leading to chronic systemic inflammation, endothelial dysfunction, atherosclerosis progression, and direct effects on cardiac performance through abnormal hormone or cytokine secretion ( 31 , 32 ). Limitations of the study The cross-sectional nature of the study makes it difficult to draw definitive conclusions between cardiovascular disease and contributing factors. Only a single blood glucose measurement was performed, and the level of glycated hemoglobin was not assessed, which made the diagnosis of diabetes difficult. Conclusions The magnitude of CVD was high in this study. Educational status, family history of cardiovascular disease, duration of ART, and triglyceride concentration >150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. To increase early detection and early care, the services of HIV care that need to integrate both service areas of NCDs have been recommended as a solution to decrease the burden of CVDs, which can help with disease prevention and health promotion. Further prospective studies need to be performed to determine the effect of HIV on cardiovascular disease. Abbreviations ANC - Antenatal Care, AOR - Adjusted odds ratio, ART- Antiretroviral Therapy, AZT – Zidovudine, BMI - Body Mass Index, CI - Confidence Interval, CVD - Cardiovascular disease, EDHS - Ethiopia demographic and health survey, EFV – Efavirenz, ETB - Ethiopian birr, HAART - Highly Active Antiretroviral Therapy, HDL-c – High-Density Lipoproteins cholesterol, HIV - Human immunodeficiency virus, IRB - Institutional Review Board, LDL-c – Low-Density Lipoproteins cholesterol, LPV/r – Lapinavir, 3TC – Lamivudine, NNRTI - Non-Nucleoside Reverse Transcriptase Inhibitor, NRTI - Nucleoside Reverse Transcriptase Inhibitor, OR - Odds Ratio, WHO - World Health Organization Declarations Ethical approval and consent to participate This study was approved by the ethics review committee of St. Paul’s Hospital Millennium Medical College School of Nursing Research Ethics Review Committee (RERC) and Addis Ababa Health Bureau Research Directorate conforms to the code of ethics of the Helsinki declaration in 2013. The participants were informed about the purposes of the study as well. The confidentiality and privacy of the participants during the data collection procedure were assured by providing written consent and explaining the objective of the study. A letter of ethical clearance, as well as a letter of cooperation, was sent for the study hospitals to undertake the data collection. Data availability statement The data will be available upon request from the corresponding author. Conflict of interest statement The authors declare no conflicts of interest. Funding The authors declare(s) that no financial support was received for the research, authorship, and/or publication of this article. Author contributions TY: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review and editing; SF: Data curation, Investigation, Methodology, Project administration, Resources, Writing—original draft, Writing—review and editing; BY: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization AA: Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review and editing; MM: Software, Supervision, Validation, Visualization, Writing—original draft, Writing—review and editing; CE: Writing—original draft, Writing—review and editing; EI: Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Visualization, Writing—original draft, Writing—review and editing. Acknowledgments The authors would like to express our gratitude to St. Paul’s Hospital Millennium Medical College. We also thank the Heads of Health Institutions and Data Collectors. References Chhoun P, Ngin C, Tuot S, Pal K, Steel M, Dionisio J, et al. Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study. International journal for equity in health. 2017;16(1):125. Haldane V, Legido-Quigley H, Chuah FLH, Sigfrid L, Murphy G, Ong SE, et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS care. 2018;30(1):103–15. Ekrikpo UE, Akpan EE, Ekott JU, Bello AK, Okpechi IG, Kengne AP. Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study. BMJ open. 2018;8(7):e019664. Chhoun P, Ngin C, Tuot S, Pal K, Steel M, Dionisio J, et al. Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study. International journal for equity in health. 2017;16(1):125. Sliwa K, Carrington MJ, Becker A, Thienemann F, Ntsekhe M, Stewart S. Contribution of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic to de novo presentations of heart disease in the Heart of Soweto Study cohort. European Heart Journal. 2012;33(7):866–74. Ntusi NB, Taylor D, Naidoo NG, Mendelson M. Progressive human immunodeficiency virus-associated vasculopathy: time to revise antiretroviral therapy guidelines? Cardiovascular Journal of Africa. 2011;22(4):197–200. Freiberg MS, Chang CC, Kuller LH, Skanderson M, Lowy E, Kraemer KL, et al. HIV infection and the risk of acute myocardial infarction. JAMA Internal Medicine. 2013;173(8):614–22. Bloomfield GS, Mwangi A, Chege P, Simiyu CJ, Aswa DF, Odhiambo D, et al. Multiple cardiovascular risk factors in Kenya: evidence from a health and demographic surveillance system using the WHO STEPwise approach to chronic disease risk factor surveillance. Heart (British Cardiac Society). 2013;99(18):1323–9. Nyirenda M, Newell ML, Mugisha J, Mutevedzi PC, Seeley J, Scholten F, et al. Health, well-being, and disability among older people infected or affected by HIV in Uganda and South Africa. Global health action. 2013;6:19201. Niakara A, Drabo YJ, Kambire Y, Nebie LV, Kabore NJ, Simon F. [Cardiovascular diseases and HIV infection: study of 79 cases at the National Hospital of Ouagadougou (Burkina Faso)]. Bulletin de la Societe de pathologie exotique (1990). 2002;95(1):23 – 6. Remais JV, Zeng G, Li G, Tian L, Engelgau MM. Convergence of non-communicable and infectious diseases in low- and middle-income countries. International journal of epidemiology. 2013;42(1):221–7. Todowede OO, Sartorius B, Magula N, Schutte AE. Association of predicted 10 years cardiovascular mortality risk with duration of HIV infection and antiretroviral therapy among HIV-infected individuals in Durban, South Africa. Diabetology & metabolic syndrome. 2019;11:105. Cerrato E, Calcagno A, D'Ascenzo F, Biondi-Zoccai G, Mancone M, Grosso Marra W, et al. Cardiovascular disease in HIV patients: from bench to bedside and backward. Open heart. 2015;2(1):e000174. Dimala CA, Blencowe H, Choukem SP. The association between antiretroviral therapy and selected cardiovascular disease risk factors in sub-Saharan Africa: A systematic review and meta-analysis. PloS one. 2018;13(7):e0201404. Edwards JK, Bygrave H, Van den Bergh R, Kizito W, Cheti E, Kosgei RJ, et al. HIV with non-communicable diseases in primary care in Kibera, Nairobi, Kenya: characteristics and outcomes 2010–2013. Transactions of the Royal Society of Tropical Medicine and Hygiene. 2015;109(7):440–6. Siedner MJ, Kim JH, Nakku RS, Bibangambah P, Hemphill L, Triant VA, et al. Persistent Immune Activation and Carotid Atherosclerosis in HIV-Infected Ugandans Receiving Antiretroviral Therapy. The Journal of Infectious Diseases. 2016;213(3):370–8. Cerrato E, D'Ascenzo F, Biondi-Zoccai G, Calcagno A, Frea S, Grosso Marra W, et al. Cardiac dysfunction in pauci symptomatic human immunodeficiency virus patients: a meta-analysis in the highly active antiretroviral therapy era. European Heart Journal. 2013;34(19):1432–6. Osetinsky B, Genberg BL, Bloomfield GS, Hogan J, Pastakia S, Sang E, et al. Hypertension Control and Retention in Care Among HIV-Infected Patients: The Effects of Co-located HIV and Chronic Noncommunicable Disease Care. Journal of Acquired Immune Deficiency Syndromes (1999). 2019;82(4):399–406. Abebe M, Kinde S, Belay G, Gebreegziabxier A, Challa F, Gebeyehu T, et al. Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: a cross-sectional comparative study. BMC research notes. 2014;7:380. Sewale Y, Afenigus AD, Haile D, Shiferaw WS. The magnitude of Hypertension and Associated Factors Among Human Immunodeficiency Virus Positive Adults Receiving Anti-Retroviral Therapy at Debre Markos Referral Hospital, Northwest, Ethiopia. HIV/AIDS (Auckland, NZ). 2020;12:629–37. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). Jama. 2001;285(19):2486–97. Meier S, Seeburger J, Borger MA. Advances in Mitral Valve Surgery. Current treatment options in cardiovascular medicine. 2018;20(9):75. Al-Makki A, DiPette D, Whelton PK, Murad MH, Mustafa RA, Acharya S, et al. Hypertension Pharmacological Treatment in Adults: A World Health Organization Guideline Executive Summary. Hypertension (Dallas, Tex: 1979). 2022;79(1):293–301. Witchakorn Ruamtawee1, Mathuros Tipayamongkholgul1*, Natnaree Aimyong1 and Weerawat ManosuthiPrevalence and risk factors cardiovascular disease among people living with HIV in the Asia-Pacific region: a systematic review: Ruamtawee et al. BMC Public Health (2023) 23:477 https://doi.org/10.1186/s12889-023-15321-7 . Pierre S, Seo G, Rivera VR, Walsh KF, Victor JJ, Charles B, et al. Prevalence of hypertension and cardiovascular risk factors among long-term AIDS survivors: A report from the field. Journal of clinical hypertension (Greenwich, Conn). 2019;21(10):1558–66. Aurpibul L, Srithanaviboonchai K, Rerkasem K, Tangmunkongvorakul A, Sitthi W, Musumari PM. Prevalence of subclinical atherosclerosis and risk of athero sclerotic Cardiovascular Disease in older adults living with HIV. AIDS Res Hum Retroviruses. 2019;35(11–12):1136–42. Wongcharoen W, Khienprasit K, Phrommintikul A, Sukonthasarn A, Chat tipakorn N. Heart rate variability and heart rate turbulence in HIV-infected patients receiving combination antiretroviral therapy. Annals of noninvasive electrocardiology: the official journal of the International Society for Holter and Noninvasive Electrocardiology Inc. 2013;18(5):450–6. Batwala V, Magnussen P, Nuwaha F. Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda. Malaria journal. 2011;10:373. Grinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. The New England journal of medicine. 2005;352(1):48–62. Phalane E, Fourie CMT, Mels CMC, Schutte AE. A comparative analysis of blood pressure in HIV-infected patients versus uninfected controls residing in Sub-Saharan Africa: a narrative review. Journal of human hypertension. 2020;34(10):692–708. Ballocca F, Gili S, D’Ascenzo F, Marra WG, Cannillo M, Calcagno A, et al. HIV infection and primary Prevention of Cardiovascular Disease: lights and Shad ows in the HAART era. Prog Cardiovasc Dis. 2016;58(5):565–76. Low Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: Cardiovascular Disease in Diabetes Mellitus: atherosclerotic Cardiovascular Disease and Heart failure in type 2 diabetes Mellitus - Mechanisms, Management, and clinical considerations. Circulation. 2016;133(24):2459–502. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4571158","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321111650,"identity":"f9a87dd1-1912-4f13-8086-dfadabe26d74","order_by":0,"name":"Tagese Yakob 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15:01:35","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4571158/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4571158/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60343884,"identity":"4956a454-e1a9-4e0b-a2e1-9adf3ea31b67","added_by":"auto","created_at":"2024-07-15 19:19:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":418305,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"figure1and211.png","url":"https://assets-eu.researchsquare.com/files/rs-4571158/v1/91cbdfaeeeeec556ddf402dc.png"},{"id":60343883,"identity":"7c8eaa53-9b18-42b5-b2cd-0b44dac6be1c","added_by":"auto","created_at":"2024-07-15 19:19:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":160775,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"figure1and212.png","url":"https://assets-eu.researchsquare.com/files/rs-4571158/v1/183666dd0127f9b20952c56e.png"},{"id":72745197,"identity":"73783a5f-86e3-423c-9ccc-1ce733918159","added_by":"auto","created_at":"2025-01-01 12:16:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1617208,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4571158/v1/ba194f89-bd89-4260-b0d0-c257d950eeed.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Magnitude of Cardiovascular Diseases and Associated Factors of among Human Immune Deficiency Positive Patients on Ant- Retroviral Therapy in Ethiopia: Multicenter Cross-Sectional Study","fulltext":[{"header":"Background","content":"\u003cp\u003eCardiovascular diseases (CVDs) have been identified as the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLHIV)(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The improved survival rate of PLHIV and changing HIV disease patterns have resulted in a growing burden of multi-morbidity (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Crucially, the changing landscape of HIV clinical care, as recent evidence suggests that HIV-associated inflammation and immune activation are important mediators of cardiovascular risks. Globally, at least 84% of PLHIV are diagnosed with one non-communicable disease (NCD) by 2030 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is the leading cause of death globally (31%) and in Africa (11.3%)(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong patients with heart disease, up to 9.7% are infected with HIV (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). All heart structures are involved, the severity of which correlates with that of immune deficiency (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). PLWH are at increased risk for CVD (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e), and access to ART has expanded; additionally, more PLWH are living past 50 years of age (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) and facing an increased risk of CVD due to traditional CVD risk factors alone (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). HIV infection and the metabolic effects associated with ART increase the burden of cardiovascular disease in low-income countries (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In the context of the increasing availability of ART for patients even at the early stage of HIV infection, as deaths due to HIV-associated opportunistic infections are decreasing, increased rates of mortality due to HIV-associated cardiovascular disease are expected among HIV-infected adults (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWith the demographic and epidemiological transition from infectious diseases to NCDs in Sub-Saharan Africa (SSA), there is a growing burden of CVD due to, among other factors, rapid urbanization, economic changes, and concomitant nutrition transitions (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The increased risk has been linked to traditional CVD risk factors, HIV infection itself, antiretroviral regimens, and the immunological dynamics that originate from the infection (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A systematic review and meta-analysis among HIV-infected populations in SSA countries indicated a strong association between the use of antiretroviral therapy (ART) and mortality due to CVD (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This is attributed to the aging population of people living with HIV, ART, HIV-related inflammation, and traditional lifestyle risk factors such as smoking, alcohol intake, and inactivity (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies on the association between cardiovascular risk factors and HIV are mainly from developed countries, yet SSA accounts for 67% of the global burden of HIV (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Analyzing the distribution of cardiovascular risk factors among persons living with HIV in SSA is important due to the known cardiovascular effects of HIV and the high prevalence of HIV (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). As a result of the success and scale-up of ART over the past fifteen years, HIV has become a chronic disease with increased life expectancy and aging among patients in SSA countries, including Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). The use of highly active antiretroviral therapy (HAART) has been linked to hyperglycemia, dyslipidemia, and increased risk of CVD in HIV-infected patients (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, epidemiological data on cardiovascular disease in HIV-infected individuals are still scarce, and due to different occasions, attention to HIV/AIDS has been neglected; moreover, the burden of CVD risk factors among HIV patients has not been well studied (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and studies using a representative sample are particularly scarce in Ethiopia. Therefore, this study aimed to assess the magnitude and associated factors of cardiovascular diseases among HIV-positive patients on ART in governmental hospitals in Addis Ababa, Ethiopia.\u003c/p\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e\u003cb\u003eStudy area, study period, and design\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eThe study was conducted in Addis Ababa, Ethiopia. Addis Ababa, the capital city of the Federal Democratic Republic of Ethiopia, is located at the center of the country. The city has 11 sub-cities and 116 Woredas. There are 13 governmental hospitals in Addis Ababa, of which 6 are administered by the Addis Ababa City Organization Health Bureau, 4 by the Federal Ministry of Health (FoMH), 1 by Addis Ababa University, and 3 by Defense Constraint and Police. The hospitals were selected by the lottery method. Hence, Tikur Anbessa Specialized Hospital, St. Peter Specialized Hospital, Alert Hospital and Minillik II Hospital were selected for the current study. Tikur Anbessa Specialized Hospital is the largest referral and teaching hospital in Ethiopia and is operated by the Ministry of Education of Ethiopia. Minillik II Hospital is managed by the Addis Ababa Administrative Health Office. St. Peter\u0026rsquo;s specialized hospital is also another referral hospital that is administered under the Federal Ministry of Health. The duration of the study ranged from February to March 2023. An institution-based cross-sectional study was conducted among patients with HIV on ART at selected governmental hospitals in Addis Ababa.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eThe source population was all HIV-infected patients who underwent ART follow-up at governmental hospitals in Addis Ababa, and the study populations were all HIV-infected adult patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years receiving HIV care and who received ART follow-up at selected governmental hospitals in Addis Ababa. All adults aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years and HIV-infected patients with HAART attending selected governmental hospitals in Addis Ababa for more than six months and those who were willing to participate in the study included were pregnant and lactating women, and those with documented hypertension, diabetes, or dyslipidemia before starting HAART were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSample size determination\u003c/h2\u003e \u003cp\u003eThe sample size was determined using a single population proportion formula by taking 41.3% of the incidence of cardiovascular diseases among HIV-infected adults from a similar study in Debre Markos Referral Hospital, Northwest Ethiopia (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Considering the following assumptions, z\u0026thinsp;=\u0026thinsp;standard normal distribution value at a 95% confidence level of zα/2\u0026thinsp;=\u0026thinsp;1.96 and margin of error (d)\u0026thinsp;=\u0026thinsp;5%. The calculated sample size was 372, and by adding a 10% nonresponse rate, the final sample size was 409.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSampling technique\u003c/h2\u003e \u003cp\u003eA systematic random sampling technique was used to identify the study subjects and 600 adult HIV-infected patients who were receiving ART at Tikur Anbessa Specialized Hospital, 700 at Minillik II Hospital, 250 at St, Petros Hospital, and 300 at Alert Hospital ART clinics for an average of one month. The sampling interval was calculated by using the formula k\u0026thinsp;=\u0026thinsp;N/n, which is 1850/409, K\u0026thinsp;=\u0026thinsp;4.52\u0026asymp;5, and the initial sample was selected using the lottery method. Therefore, every 5th patient who attended ART clinics was enrolled in the study until the calculated sample size was achieved within the length of the data collection period (Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003eThe burden of cardiovascular disease was the dependent variable, and the socio-demographic factors included age, sex, marital status, sex, educational level, occupation status, and income; the clinical and biochemical characteristics included blood pressure, body mass index, CD4 cell count, and fasting blood sugar; and the lifestyle factors included a history of alcohol intake, salt intake, fruit and vegetable intake, and walking/day, which were some of the independent variables of the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOperational Definition and Preferred Cutoff Values\u003c/h2\u003e \u003cp\u003e \u003cb\u003eHypertension\u003c/b\u003e was defined as a systolic BP\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and/or diastolic \u003cb\u003eBP\u0026thinsp;\u0026ge;\u0026thinsp;90 mmHg. An abnormal lipid profile\u003c/b\u003e was defined as TC\u0026thinsp;\u0026ge;\u0026thinsp;200 mg/dl, HDL-c\u0026thinsp;\u0026lt;\u0026thinsp;40 mg/dl, LDL-c\u0026thinsp;\u0026ge;\u0026thinsp;130 mg/dl, TG\u0026thinsp;\u0026ge;\u0026thinsp;150 mg/dl, and a TC/HDL-c ratio\u0026thinsp;\u0026ge;\u0026thinsp;5 (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eCardiovascular diseases are defined\u003c/b\u003e as having at least one of the following: chronic rheumatic heart disease; hypertension; hypertensive heart disease; ischemic heart disease; or other heart diseases, such as cardiomyopathies, arrhythmias, or valvular heart diseases (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The outcome variable (cardiovascular disease) was measured by yes/no questions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eData collection tools and procedures\u003c/h2\u003e \u003cp\u003eThe data were collected by using a pretested, structured, and interviewer-administered questionnaire adapted from the literature reviews. The tool was validated by the World Health Organization and adapted to the Ethiopian context. A structured questionnaire and patient chart were used to collect data on the socio-demographic characteristics; patients\u0026rsquo; records were reviewed to obtain information on their current CD4\u0026thinsp;+\u0026thinsp;T-cell count and HIV and HAART status. A thorough physical examination was performed, including measurements of blood pressure and anthropometric variables. Height was measured with a meter ruler with the patients standing erect on a flat surface without shoes. Weight was recorded in kilograms using a standard weighing scale on a firm horizontal surface with patients wearing light clothing. Hypertension is diagnosed if the patient has a record of systolic blood pressure readings\u0026thinsp;\u0026ge;\u0026thinsp;140 mmHg and/or if the diastolic blood pressure readings on both days are \u0026ge;\u0026thinsp;90 mmHg on two different days(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Obesity was defined as a BMI\u0026thinsp;\u0026ge;\u0026thinsp;30.0 kg/m\u003csup\u003e2\u003c/sup\u003e. Lipid profiles were assessed through enzymatic methods (INMESCO, GmbH (L-S 04/2009)) for all participants and included total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c) and triglyceride (TG) levels taken from patient charts. The data collectors were four senior BSc nurses and two laboratory technicians who had experience in data collection procedures. The investigator supervised the daily activities. To ensure consistency, the English version of the questionnaire was translated into the local language Amharic and returned to English.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eData quality control\u003c/h2\u003e \u003cp\u003eTo maintain data quality, training was given to the data collectors. The supervisor/principal investigator supervised the data collectors on a daily basis for the completeness and consistency of the completed questionnaires. Additionally, the data were thoroughly cleaned and carefully entered into a computer at the beginning of the analysis. Pretests were performed on 5% of the study subjects outside of the study setting. The investigators and data collectors took part in a pretest of the survey questionnaire among the study subjects.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis and Interpretation\u003c/h2\u003e \u003cp\u003eAfter checking for completeness and consistency of the collected information, the data were cleaned, coded, entered into Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. The descriptive statistics (means, standard deviations, percentages, or frequencies) were calculated, and bivariate logistic regression analyses were used to determine the relationships between the dependent and independent variables. Variables with a p value of 0.25 in the bivariate analysis were considered to be associated with the dependent variable and were entered into the multivariate analysis. The strength of the association was measured using an odds ratio and interpreted by considering the 95% confidence interval and p value of 0.05 as statistically significant risk factors in multivariate analysis. Finally, the results were presented using texts, charts, and tables.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDemographics and Clinical Characteristics\u003c/h2\u003e \u003cp\u003eA total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. Of these, 260 (51.6%) were male. The mean age (SD) of the study participants was 43 (11.2) years, with the youngest participant being 20 years old and the oldest being 74 years old. More than half of the patients (268, 67.2%) were married, approximately 221 (55.4%) were government employees, and approximately 158 (39.5%) had a school-level education. Half of the 200 participants (50.15%) had a monthly income of 2501\u0026ndash;5000 ETB, and approximately 147 (36.8%) had a family history of cardiovascular disease. The mean duration of diagnosis of HIV/ADIS was 12 (\u0026plusmn;\u0026thinsp;5.1 SD) years, and the mean duration of ART use was 12 (\u0026plusmn;\u0026thinsp;5.8 SD) years. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the burden of CVD among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;399).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables(n\u0026thinsp;=\u0026thinsp;399)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCVD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAge category\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003e(Years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78(94.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109(80.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(73.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(76.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40(19.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e166(80.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(15.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163(84.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100(78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.309\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e226(84.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eOccupational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(29.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33(70.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment Employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e185(83.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate employee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(11.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(88.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63(81.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNever attended school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSchool level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(86.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCertificate level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104(74.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate and above level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(90.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMonthly income (ETB)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(20.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(79.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.907\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2501\u0026ndash;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165(82.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77(83.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDuration of HIV/ADIS diagnosis time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(81.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreater than 20years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(57.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDuration of treatment on ART\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;11years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184(78.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFamily history of cardiovascular disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113(75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216(86.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLifestyle-related factors\u003c/h2\u003e \u003cp\u003eMore than half (272, 68.2%) of the study participants acquired HIV through the heterosexual route (186, 55.4%). Nearly half of the patients (n\u0026thinsp;=\u0026thinsp;175, 43.7%) had a history of alcohol consumption in their lifetime, and approximately 32 (8%) had a history of smoking. Only 7.8% of the patients met the WHO recommendations of consuming five or more servings of fruit and vegetables per day; approximately one-third of the 266 (66.7%) patients had a history of moderate salt intake, and approximately half of the 197 (49.4) patients had a 30- to 60-minute total walking period per day (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifestyle-related factors of CVD among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCVD (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMode HIV transmission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeterosexual route\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e222(81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInjecting drug use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(85.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHistory of alcohol drink\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26(14.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e149(85.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44(19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e180(80.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHistory of smoke cigarettes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(87.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e301(82.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFruit \u0026amp; vegetable consumption/day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 portions/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(17.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e302(82.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 portions/day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27(87.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eSalt intake\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28(73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e225(84.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(80.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eHistory of total walking period per day\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 30 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(19.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e111(80.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efrom 30\u0026ndash;60 minutes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(16.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e165(83.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efrom 1\u0026ndash;2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(86.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGreater than 2 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(76.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAnthropometric and biochemical characteristics of the patients\u003c/h2\u003e \u003cp\u003eAmong the participants, the majority (82.2%) had a normal BMI, and only 5% of the patients were overweight. Participants were asked about their intake of alcohol, and 7 participants (2.1%) consumed alcohol in the last month. Participants were asked if they had ever been told to have increased blood glucose or diabetes, and 25 (6.3%) had increased blood glucose. Cholesterols were detected, and among the participants, 77 (19.3%) had a total cholesterol\u0026thinsp;\u0026gt;\u0026thinsp;200 (mg/dl), 27 (6.35) had a triglyceride\u0026thinsp;\u0026gt;\u0026thinsp;150 (mg/dl), 174 (44.1%) had an HDL-cholesterol\u0026thinsp;\u0026lt;\u0026thinsp;40 (mg/dl), and 80 (20.3%) had an LDL-cholesterol\u0026thinsp;\u0026gt;\u0026thinsp;130 (mg/dl). For nearly half (47.9%) of the participants, the CD4 count was \u0026gt;\u0026thinsp;500, and the mean systolic and diastolic pressures were 116.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15 (SD) and 73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9 (SD), respectively (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAnthropometric and biochemical characteristics of HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;399).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables(n\u0026thinsp;=\u0026thinsp;399)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCVD (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eBMI (kg/m2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnderweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46(90.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e273(83.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverweight\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eLow-density lipoprotein- cholesterol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;130 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38(13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e248(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;130 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTotal cholesterol (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;200 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e275(85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;200 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHigh-density lipoprotein-cholesterol\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.031\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31(13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e192(86.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTriglyceride (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e313(83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;150 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(59.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFasting blood glucose (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e308(82.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(84.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eCD4 Count\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(13.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(86.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e350\u0026ndash;499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28(15.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157(84.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(20.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e152(79.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean DBP Systolic blood pressure(\u0026plusmn;\u0026thinsp;SD) (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e116.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMean Diastolic blood pressure(\u0026plusmn;\u0026thinsp;SD) (mmHg)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003e73.7\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eBurden of cardiovascular diseases among HIV-positive patients\u003c/h2\u003e \u003cp\u003eThe prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61) ( \u003cb\u003eFig.\u0026nbsp;2\u003c/b\u003e). Among the patients with cardiovascular diseases, 50 (12.5%) had hypertensive disease, 10 (3.8%) had rheumatic heart disease (RHD), 7 (1.85%) had ischemic heart disease, and 10 (2.5%) had other diseases (cardiomyopathies, arrhythmias, valvular heart diseases) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEtiology of cardiovascular diseases among HIV-positive patients among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;399).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables(n\u0026thinsp;=\u0026thinsp;334)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHypertensive disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e349\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eIschemic heart disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eChronic rheumatic heart disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eHypertensive heart disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e396\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e99.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eOther(cardiomyopathies, arrhythmias, Valvular heart diseases)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eno\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e389\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with cardiovascular diseases among HIV-positive patients\u003c/h2\u003e \u003cp\u003eThe candidate variables included in the bivariate analysis for multiple variables were age, educational status, family history of CVD, duration of ART treatment, and triglyceride concentration\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl, and mode of HIV transmission was associated with CVD among HIV-positive patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.25). Educational status, family history of cardiovascular disease, duration of ART treatment, and triglyceride concentration\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. The model was fit with the Hosmer and Lemeshow test (p value\u0026thinsp;=\u0026thinsp;0.132, x\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.8).\u003c/p\u003e \u003cp\u003eAmong patients living with HIV/ADIS, those with an undergraduate education level who were living with HIV/ADIS were 79% less likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;0.21, 95% CI: (0.48\u0026ndash;0.97)) than were those with no formal education level. Among PLWH, those with a family history of cardiovascular disease were 2.02 times more likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;2.02, 95% CI: (1.12\u0026ndash;3.66)). Individuals who were receiving ART for more than 20 years were 4.38 times more likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;4.38, 95% CI: (1.36\u0026ndash;14.10)) than were those who were not receiving ART. Patients living with HIV/ADIS with triglycerides \u003cb\u003e(mg/dl)\u003c/b\u003e\u0026thinsp;\u0026gt;\u0026thinsp;150 were 2.84 times more likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;2.84, 95% CI: (1.06\u0026ndash;7.64)) than patients living with HIV/ADIS with triglycerides \u003cb\u003e(mg/dl)\u003c/b\u003e\u0026thinsp;\u0026lt;\u0026thinsp;150 (\u003cb\u003esee\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBinary logistic regression analysis for the burden of cardiovascular diseases among HIV-positive patients among HIV-positive patients on ART in Governmental Hospitals of Addis Ababa, Ethiopia, 2023 (n\u0026thinsp;=\u0026thinsp;399)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCardiovascular diseases (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ep value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003eAge category(years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e18\u0026ndash;29\u003c/p\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003cp\u003e40\u0026ndash;49\u003c/p\u003e \u003cp\u003e50\u0026ndash;59\u003c/p\u003e \u003cp\u003e50+\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43(91.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.31(0.08\u0026ndash;1.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.47(0.11\u0026ndash;1.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.308\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78(94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21(0.06\u0026ndash;0.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33(0.09\u0026ndash;1.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e109(80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.82(0.35\u0026ndash;1.94)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.06(0.39\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.905\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25(26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69(73.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20(0.50\u0026ndash;2.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.02(0.38\u0026ndash;2.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.963\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(23.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(76.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003cp\u003eSchool level\u003c/p\u003e \u003cp\u003eCertificate level\u003c/p\u003e \u003cp\u003eUndergraduate level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(33.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(66.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137(86.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.750(1.40\u0026ndash;16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.43(0.11\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104(74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45(0.61\u0026ndash;3.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.86(0.21\u0026ndash;3.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76(90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.19(1.40\u0026ndash;7.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21(0.48\u0026ndash;0.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.046\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMode of HIV transmission\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eHeterosexual route\u003c/p\u003e \u003cp\u003eInjecting drug use\u003c/p\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e222(81.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.22(0.31\u0026ndash;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.13(0.21\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.120\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(14.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e105(85.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.76(0.23\u0026ndash;1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.21(0.11\u0026ndash;2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eFamily history of cardiovascular disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36(24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113(75.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.80(107\u0026thinsp;\u0026minus;\u0026thinsp;3.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.02(1.12\u0026ndash;3.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e216(86.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eTriglyceride (mg/dl)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;150 (mg/dl)\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;150 (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59(16.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e313(83.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.64(1.618.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.84(1.06\u0026ndash;7.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.037\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(40.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16(59.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDuration of HIV/ADIS diagnosis time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;10YEARS\u003c/p\u003e \u003cp\u003e10-20years\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;20years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145(87.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1 (reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1(reference)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171(81.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.65 (0.92\u0026ndash;2.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.30(0.68\u0026ndash;2.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.419\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11(42.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13(57.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.13(2.42\u0026ndash;15.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.38(1.36\u0026ndash;14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.013\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eA total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. The prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61). The candidate variables included in the bivariate analysis for multiple variables were age, educational status, family history of cardiovascular disease, duration of ART treatment, and triglyceride concentration\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl, and mode of HIV transmission was associated with cardiovascular disease among HIV-positive patients (p\u0026thinsp;\u0026lt;\u0026thinsp;0.25). Educational status, family history of cardiovascular disease, duration of ART, and triglyceride concentration\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. The model was fit with the Hosmer and Lemeshow test (p value\u0026thinsp;=\u0026thinsp;0.132, x\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.8).\u003c/p\u003e \u003cp\u003eThe prevalence of cardiovascular diseases among adult HIV-positive patients at public hospitals in Addis Ababa was 70 (17.5%) (95% CI, 14.10-21.61). This systematic study was conducted in the Asia-Pacific region among PLHIV, and the incidence of CVD ranged from 10 to 28% (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This percentage is lower than that reported in studies conducted in Cameroon (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) and in Northwest Ethiopia (41.3%) (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This might be because HIV management may differ across regions, especially between high- and low- to middle-income countries.\u003c/p\u003e \u003cp\u003eAmong patients living with HIV/ADIS, those with an undergraduate education level who were living with HIV/ADIS were 79% less likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;0.21, 95% CI: (0.48\u0026ndash;0.97)) than were those with no formal education level. This might be due to educated people living with regularly visiting hospitals and attending health education sessions to improve healthy lifestyles to reduce the risk of NCDs (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAmong PLWH, those with a family history of cardiovascular disease were 2.02 times more likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;2.02, 95% CI: (1.12\u0026ndash;3.66)).\u003c/p\u003e \u003cp\u003eThis finding is consistent with a study conducted in an Asia-Pacific family with a steep increase in the risk for CVD(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This might be due to HIV-specific risk factors for CVD and synergistic effects between traditional and HIV-specific risk factors in the population.\u003c/p\u003e \u003cp\u003eIndividuals who were receiving ART for more than 20 years were 4.38 times more likely to develop cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;4.38, 95% CI: (1.36\u0026ndash;14.10)) than were those who were not receiving ART. This finding is consistent with a study conducted in Uganda showing that the duration of antiretroviral therapy (ART) has a significant influence on the viral load and consequently leads to CVD (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This could be because the more advanced the patient is to ART, the greater the magnitude of the potential precursor and the greater the risk of having different comorbidities.\u003c/p\u003e \u003cp\u003ePatients living with HIV/ADIS with triglycerides (mg/dl)\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl were 2.84 times more likely to develop cardiovascular disease than patients living with HIV/ADIS with triglycerides\u0026thinsp;\u0026lt;\u0026thinsp;150 mg/dl. This study aligns with a previous study (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e) in which sub-Saharan Saharan treatment was associated with increased lipid levels in sub-Saharan Africa (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and increased CVD risk in the Asia-Pacific region (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This could be due to lipid profile-related factors\u0026rsquo; major roles in increasing oxidative stress in the cardiovascular system and leading to chronic systemic inflammation, endothelial dysfunction, atherosclerosis progression, and direct effects on cardiac performance through abnormal hormone or cytokine secretion (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eThe cross-sectional nature of the study makes it difficult to draw definitive conclusions between cardiovascular disease and contributing factors. Only a single blood glucose measurement was performed, and the level of glycated hemoglobin was not assessed, which made the diagnosis of diabetes difficult.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe magnitude of CVD was high in this study. Educational status, family history of cardiovascular disease, duration of ART, and triglyceride concentration \u0026gt;150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. To increase early detection and early care, the services of HIV care that need to integrate both service areas of NCDs have been recommended as a solution to decrease the burden of CVDs, which can help with disease prevention and health promotion. Further prospective studies need to be performed to determine the effect of HIV on cardiovascular disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC - Antenatal Care, AOR - Adjusted odds ratio, ART- Antiretroviral Therapy, AZT \u0026ndash; Zidovudine, BMI - Body Mass Index, CI - Confidence Interval, CVD - Cardiovascular disease, EDHS - Ethiopia demographic and health survey, EFV \u0026ndash; Efavirenz, ETB - Ethiopian birr, HAART - Highly Active Antiretroviral Therapy, HDL-c \u0026ndash; High-Density Lipoproteins cholesterol, HIV - Human immunodeficiency virus, IRB - Institutional Review Board, LDL-c \u0026ndash; Low-Density Lipoproteins cholesterol, LPV/r \u0026ndash; Lapinavir, 3TC \u0026ndash; Lamivudine, NNRTI - Non-Nucleoside Reverse Transcriptase Inhibitor, NRTI - Nucleoside Reverse Transcriptase Inhibitor, OR - Odds Ratio, WHO - World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the ethics review committee of St. Paul\u0026rsquo;s Hospital Millennium Medical College\u0026nbsp;School of Nursing Research Ethics Review Committee (RERC) and Addis Ababa Health Bureau Research Directorate conforms to the code of ethics of the Helsinki declaration in 2013. The participants were informed about the purposes of the study as well. The confidentiality and privacy of the participants during the data collection procedure were assured by providing written consent and explaining the objective of the study. A letter of ethical clearance, as well as a letter of cooperation, was sent for the study hospitals to undertake the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data will be available upon request\u0026nbsp;from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026nbsp;declare no conflicts\u0026nbsp;of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare(s) that no financial support was received for the research, authorship, and/or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTY: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing; SF: Data curation, Investigation, Methodology, Project administration, Resources, Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing; BY: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization AA: Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing; MM: Software, Supervision, Validation, Visualization, Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing; CE: Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing; EI: Conceptualization, Data curation, Methodology, Project administration, Supervision, Validation, Visualization, Writing\u0026mdash;original draft, Writing\u0026mdash;review and editing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express our gratitude to St. Paul\u0026rsquo;s Hospital Millennium Medical College. We also thank the Heads of Health Institutions and Data Collectors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChhoun P, Ngin C, Tuot S, Pal K, Steel M, Dionisio J, et al. Non-communicable diseases and related risk behaviors among men and women living with HIV in Cambodia: findings from a cross-sectional study. International journal for equity in health. 2017;16(1):125.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHaldane V, Legido-Quigley H, Chuah FLH, Sigfrid L, Murphy G, Ong SE, et al. Integrating cardiovascular diseases, hypertension, and diabetes with HIV services: a systematic review. AIDS care. 2018;30(1):103\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkrikpo UE, Akpan EE, Ekott JU, Bello AK, Okpechi IG, Kengne AP. Prevalence and correlates of traditional risk factors for cardiovascular disease in a Nigerian ART-naive HIV population: a cross-sectional study. 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Comparative feasibility of implementing rapid diagnostic test and microscopy for parasitological diagnosis of malaria in Uganda. Malaria journal. 2011;10:373.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrinspoon S, Carr A. Cardiovascular risk and body-fat abnormalities in HIV-infected adults. The New England journal of medicine. 2005;352(1):48\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePhalane E, Fourie CMT, Mels CMC, Schutte AE. A comparative analysis of blood pressure in HIV-infected patients versus uninfected controls residing in Sub-Saharan Africa: a narrative review. Journal of human hypertension. 2020;34(10):692\u0026ndash;708.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBallocca F, Gili S, D\u0026rsquo;Ascenzo F, Marra WG, Cannillo M, Calcagno A, et al. HIV infection and primary Prevention of Cardiovascular Disease: lights and Shad ows in the HAART era. Prog Cardiovasc Dis. 2016;58(5):565\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLow Wang CC, Hess CN, Hiatt WR, Goldfine AB. Clinical update: Cardiovascular Disease in Diabetes Mellitus: atherosclerotic Cardiovascular Disease and Heart failure in type 2 diabetes Mellitus - Mechanisms, Management, and clinical considerations. Circulation. 2016;133(24):2459\u0026ndash;502.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, cardiovascular diseases, risk factors, HIV, HAART","lastPublishedDoi":"10.21203/rs.3.rs-4571158/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4571158/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eCardiovascular disease (CVD) has been identified as the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLHIV). Therefore, it is important to determine the risk of cardiovascular disease (CVD) from multiple centers.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to determine the burden and associated factors of cardiovascular disease among HIV-positive patients on antiretroviral therapy (ART) in hospitals in Ethiopia.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eThis was an institutionally based cross-sectional study of 409 adult HIV-infected patients who were receiving ART for at least six months from February 1\u0026ndash;30, 2023. A systematic random sampling technique was employed to select the study participants, and the data were collected through face-to-face interviews using a structured questionnaire. The data were cleaned, coded, and entered into Epi-data version 4.6.0.2 and exported to STATA version 14 for analysis. For descriptive statistics, both bivariate and multivariable logistic regression analyses were employed. Variables with a P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in the multivariable logistic regression analysis were considered determinant factors for cardiovascular disease among HIV-infected patients.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 399 HIV-infected patients on ART participated in the study, for a response rate of 97.5%. The prevalence of cardiovascular diseases among adult HIV-positive patients was 70 (17.5%) (95% CI, 14.10-21.61). An undergraduate education level of patients living with HIV/ADIS (AOR\u0026thinsp;=\u0026thinsp;0.21, 95% CI: (0.48\u0026ndash;0.97)), a family history of cardiovascular disease (AOR\u0026thinsp;=\u0026thinsp;2.02, 95% CI: (1.12\u0026ndash;3.66), duration of ART treatment (AOR\u0026thinsp;=\u0026thinsp;4.38, 95% CI: (1.36\u0026ndash;14.10), and living with HIV/ADIS with triglycerides (mg/dl)\u0026thinsp;\u0026gt;\u0026thinsp;150 (AOR\u0026thinsp;=\u0026thinsp;2.84, 95% CI: (1.06\u0026ndash;7.64) independently predicted cardiovascular disease among HIV/ADIS patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe magnitude of CVD incidence was high in this study. Educational status, family history of cardiovascular disease, duration of ART, and triglyceride concentration\u0026thinsp;\u0026gt;\u0026thinsp;150 mg/dl were significantly associated with cardiovascular disease among HIV-positive individuals. To increase early detection and early care, HIV care services need to integrate NCDs in both service areas, which has been recommended as a solution to decrease the burden of CVD.\u003c/p\u003e","manuscriptTitle":"Magnitude of Cardiovascular Diseases and Associated Factors of among Human Immune Deficiency Positive Patients on Ant- Retroviral Therapy in Ethiopia: Multicenter Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 19:18:53","doi":"10.21203/rs.3.rs-4571158/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3439a0a6-a6ee-47f7-926d-228674c918d2","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33945224,"name":"Health sciences/Cardiology"},{"id":33945225,"name":"Health sciences/Diseases"},{"id":33945226,"name":"Health sciences/Health care"},{"id":33945227,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-01-01T12:08:16+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 19:18:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4571158","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4571158","identity":"rs-4571158","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}