Sex differences in cardiometabolic profiles and 10-year cardiovascular disease risk among people with HIV in Uganda: a cross-sectional study

The incidence of specific cardiovascular diseases (CVD) differs by sex among people with HIV (PWH) but differences in CVD risk factors are not well characterised. The study aim was to compare the burden of CVD risk factors and 10-year CVD risk between males and females with HIV in Uganda. We conducted a cross-sectional study among adult PWH (≥ 18 years) receiving antiretroviral therapy at Kiruddu National Referral Hospital in Kampala, Uganda. Participants completed a study questionnaire, underwent anthropometric measurements, and provided blood samples for fasting blood glucose, glycated hemoglobin, lipid profile, and serum uric acid assessments. The 10-year CVD risk was evaluated using the Framingham Risk Score. Of the 396 participants, 211 (53.3%) were female. Males reported a higher frequency of smoking (31.5% vs. 9.6%), current alcohol use (38.4% vs. 22.3%), and hazardous alcohol use (10.8% vs. 1.0%), p < 0.001. Males also had higher systolic BP (123.0 vs. 118.3 mmHg, p = 0.002), diastolic BP (83.0 vs. 79.0 mmHg, p = 0.015), triglycerides (1.7 vs. 1.4 mmol/L, p = 0.008), neck circumference (35.6 vs. 32.7 cm, p < 0.001), and serum uric acid (335.4 vs. 266.9 µmol/l, p < 0.001). In contrast, females had a higher frequency of family history of hypertension (81.8% vs. 65.4%, p = 0.015), higher body mass index (BMI) (24.8 vs. 22.8 kg/m²), waist circumference (83.5 vs. 81.5 cm), and higher frequency of central obesity (58.9% vs. 39.5%) and high BMI (≥ 25 kg/m²) (49.0% vs. 26.5%), p < 0.001. Females also had higher total cholesterol (4.6 vs. 4.4 mmol/L, p = 0.008), LDL-c (3.0 vs. 2.8 mmol/L, p = 0.010), and frequency of dyslipidemia (93.3% vs. 84.6%, p = 0.006). Female sex was independently associated with central obesity (adjusted prevalence ratio [aPR] = 1.78, 95% confidence interval [CI]: 1.28–2.49, p = 0.001), obesity (aPR = 2.40, 95% CI: 1.07–5.38, p = 0.034), and dyslipidemia (aPR = 1.12, 95% CI: 1.02–1.22, p = 0.020). Male sex was associated with smoking history (aPR = 1.85, 95% CI 1.08, 3.23, p = 0.027). Further, more males had a moderate/high 10-year CVD risk compared to females (17.1% vs. 0.5%, p < 0.001). These findings highlight the need for sex-specific approaches to cardiometabolic risk assessment and management among PWH in Uganda, while underscoring the importance of validating CVD risk prediction tools in this population. Not applicable.