Prevalence and determinants of cardiometabolic comorbidities among people living with HIV receiving antiretroviral therapy at Zewditu Memorial Hospital: evidence from Ethiopia’s longest serving AIDS clinic

BACKGROUND: The advent of highly active antiretroviral therapy (HAART) has significantly improved life expectancy among People Living with HIV (PLHIV). However, this success has been accompanied by an unprecedented rise in non-communicable diseases, particularly cardiometabolic comorbidities. While evidence from Sub-Saharan Africa demonstrates the significance of these comorbidities, comprehensive data from Ethiopia remains limited. OBJECTIVE: To determine the prevalence and identify the clinical, behavioral, and antiretroviral therapy-related factors associated with cardiometabolic comorbidities among PLHIV receiving antiretroviral therapy at Zewditu Memorial Hospital. METHODS: A cross-sectional study was conducted from February 15 to April 15, 2023. Data was collected through interviews, physical assessments, laboratory analyses, and medical records using a pretested WHO questionnaire adapted from the WHO STEPwise approach to chronic disease risk factor surveillance adapted for Ethiopia. Participants were classified as having cardiometabolic comorbidities if they presented with at least one of hypertension, diabetes mellitus, or dyslipidemia. Prevalence was estimated using descriptive proportions, and factors associated with comorbidities were identified through univariable and multivariable logistic regression analyses. RESULTS: Among 425 participants (62.1% female; mean age 48.5 ± 11 years), mean BMI was 25 ± 4.3 kg/m² and 11.8% had a smoking history. Most (76.0%) used Dolutegravir-based regimen; mean HIV diagnosis and ART durations were 13.3 ± 4.7 and 12.7 ± 4.8 years, respectively. Period prevalence of cardiometabolic comorbidities was 79.1% (95% CI: 75.2–83.0). Dyslipidemia was most prevalent [68.5% (95% CI: 64.03–72.9)], followed by hypertension [31.8% (27.3–36.2)] and diabetes [16.9% (13.4–20.5)]. Co-occurrence included: all three conditions (8.7%), hypertension/dyslipidemia (22.6%), diabetes/dyslipidemia (14.1%), and hypertension/diabetes (10.1%). PLHIV aged ≥ 40 years had over twice the odds of cardiometabolic comorbidities compared to those < 40, adjusted odds ratio (AOR) 2.13; 95% CI: 1.22–4.13). Each unit BMI increase raised odds by 9% (AOR 1.09; 1.01–1.16) and family history of hypertension nearly doubled the risk (AOR 1.98; 1.06–4.22). Conversely, WHO stage II patients had a 60% lower likelihood than stage I (AOR 0.40; 0.22–0.73). CONCLUSION: Cardiometabolic comorbidities are highly prevalent among PLHIV, particularly with advanced age, higher BMI, and family history. This burden necessitates integrated metabolic screening, signaling a transition from infectious disease management toward comprehensive chronic metabolic care. CLINICAL TRIAL NUMBER: Not applicable.