Cardiovascular risk profiles in people living with HIV taking antiretroviral therapy in rural Lesotho: Findings from the PRECARIF study

Background: With antiretroviral therapy (ART), people living with HIV (PLHIV) have near-normal life expectancies. As PLHIV get older, diagnosing and managing cardiovascular diseases (CVDs) becomes important. Data on the prevalence of CVD risk factors in PLHIV in Southern Africa remain limited. Objectives: To determine the prevalence of cardiovascular risk factors among PLHIV receiving ART in Lesotho, Southern Africa. Method: We prospectively enrolled PLHIV who were receiving ART and attending care at five healthcare facilities in Lesotho between 04 June 2024 and 28 October 2024. Demographic information, medical history, blood pressure, blood glucose, lipid profile, and body-mass-index were measured, and lifestyle risk factors data (tobacco use, alcohol intake, physical activity, diet) were collected. The Framingham risk score (FRS) estimated the 10-year CVD risk. Results: Of 343 participants, 66.2% were women, and the median age was 50 years (interquartile range 41–59 years old). The prevalence of elevated blood pressure was 49.3%, diabetes mellitus 9.6%, dyslipidaemia 70.6%, and overweight or obesity 62.7%. Tobacco use was reported by 25.7% and alcohol use by 53.6%, of whom 20.1% were heavy drinkers. Of the 343, 89.8% walked or cycled ≥ 10 min daily to commute, 40.2% reported extra salt intake, and 37.0% ate a balanced meal at most once a week. Based on the FRS, 17.6% had a medium and 12.5% a high 10-year CVD risk. Conclusion: Cardiovascular risk factors are highly prevalent among PLHIV on ART in Lesotho, with nearly one-third at medium or high 10-year CVD risk. These findings support integration of CVD risk management into HIV care in Lesotho.