Age-Driven Cardiovascular Risk Scores Differ Across Antiretroviral Regimens Among People Living with HIV in the Colombian Caribbean Region

Background/Objectives: People living with HIV (PLHIV) face an elevated burden of cardiovascular disease, and general-population and HIV-specific risk scores are commonly used for stratification, though data from Latin America, particularly Colombia’s Caribbean region, remain scarce. This study aimed to determine the distribution of cardiovascular risk, assessed through the Framingham, ASCVD ACC/AHA, and D:A:D scores, and to compare these scores across antiretroviral therapy (ART) regimens among PLHIV individuals in the Colombian Caribbean region. Methods: This cross-sectional study included 147 adult PLHIV patients receiving ART at care sites across the Colombian Caribbean. Sociodemographic, clinical, immunovirological, and treatment-related variables were compared across cardiovascular risk categories (low, moderate, high) using the Kruskal–Wallis test for continuous variables and Chi-squared or Fisher’s exact tests for categorical variables, as appropriate to expected cell counts. Agreement between the three scores was assessed with weighted Cohen’s kappa. Factors independently associated with high cardiovascular risk were evaluated using Bayesian multivariate logistic regression (full and parsimonious models). Results: All three cardiovascular risk scores differed significantly across ART regimen groups (p ≤ 0.005), with INSTI-containing regimens showing the highest scores. Agreement between scores was substantial between Framingham and ASCVD (κ = 0.717) and moderate between Framingham and D:A:D (κ = 0.534), and fair between ASCVD and D:A:D (κ = 0.321). Neither CD4+ count nor viral load status differed significantly by risk category. In multivariate analysis, age was the only variable independently associated with high cardiovascular risk (adjusted OR 1.34, 95% CI 1.18–1.53). Conclusions: Cardiovascular risk stratification in this Caribbean Colombian HIV cohort is driven primarily by chronological age; univariate differences by ART regimen group did not persist after formal comparison against an age-only model (likelihood-ratio p = 0.215), and are more consistent with channeling of older, higher-comorbidity patients toward INSTI-based regimens than with a direct pharmacological effect. Agreement between the three risk scores ranged from fair to substantial, indicating that scoring-system choice can meaningfully alter risk classification independently of virological or immunological control. These findings support age-focused cardiovascular monitoring in PLHIV individuals and caution against relying on a single, non-locally validated risk score in this population.