Estimating public health costs of cardiovascular risk in HIV patients: a predictive model (Kenya)

Abstract Introduction Over the past thirty years, the prognosis and quality of life of HIV-positive patients have dramatically improved, evolving from a fatal condition to a manageable chronic disease. HIV chronicity has unveiled long-term complications, notably the growing burden of non-communicable diseases (NCDs), particularly cardiovascular diseases (CVDs). Kenya serves as a key case study for examining the intersection of HIV and NCDs in Sub-Saharan Africa. This study aims to predict the 10-year cardiovascular risk among HIV-positive individuals in Kenya and assess the potential economic burden for health and social systems. Materials and methods We conducted a retrospective multicenter analysis using data from the CHAO study, a cross-sectional survey of HIV-positive patients attending 25 randomly selected Primary Health Care Centers in Meru County (2016-2021). Eligible participants were adults on ART, voluntarily enrolled during local health events. Cardiovascular risk was calculated using the non-laboratory WHO CVD risk charts for East Sub-Saharan Africa via the R package whoishRisk. Patients were stratified by gender, ART duration, and HIV diagnosis time. Cardiovascular event projections were multiplied by two cost scenarios (USD 2,800 and 8,600 per event) to estimate the 10-year economic impact at local and national levels. Results Among 1,032 patients (mean age 47, 74.5% women), 21% showed a ≥ 10% 10-year CVD risk. Higher risk was associated with male sex, alcohol use (OR 2.02; 95% CI: 1.37-2.94), and infectious comorbidities (OR 1.76; 95% CI: 1.07-2.85). The model forecasts 1,861 CVD events in Meru and 107,900 nationally over 10 years. Estimated costs range from USD 5.2M-16M in Meru and USD 302M-928M nationwide, depending on per-event costs. Conclusions Targeted and sustainable strategies integrating HIV and CVD care are urgently needed. Prevention, early diagnosis, and coordinated chronic care can improve health outcomes and reduce long-term public health costs. Key messages • Our findings highlight the emerging CVD burden in HIV-positive populations and support integrated care models as key to mitigating future health and economic challenges. • The rising cost of HIV-related cardiovascular events underscores the need for sustainable public health strategies and integrated care to reduce long-term economic burden.