The effect of combined antiviral therapy on blood lipids and cardiovascular disease risk in human immunodeficiency virus infected individuals

XIA Yuchao; YANG Xuan; GAN Yuan; ZHANG Xiaohua; LI Qiong; WANG Xueting

doi:10.3969/j.issn.1007-8134.2025.04.007

Abstract：Objective To investigate the effects of people living with human immunodeficiency virus(PLWH)combined with combination antiretroviral therapy(cART)on the risk of blood lipids and cardiovascular diseases,and to analyse the risk factors for hyperlipidaemia.Methods retrospective cohort study was conducted,selecting newly treated PLWH patients in the Infection and Immunity Clinic of Henan Provincial Infectious Disease Hospital from June 2018 to January 2020.Data on serum lipids,blood pressure,diabetes mellitus,HIV load,and CD4+T cell levels were collected at baseline,and after 1,3,and 5 years of cART,respectively.The 10-year CVD risk was evaluated using the Framingham score,and the risk factors for hyperlipidaemia in PLWH were analysed by univariate and multivariate analysis.Results A total of 318 cases of PLWH were enrolled,including 289 males(90.88%).Age 35(29,46)years.The changes in blood lipids after cART in PLWH showed an increase in the incidence of hyperlipidemia and a decrease in the incidence of low high-density lipoprotein cholesterol(HDL-C).The incidence of hypertriglyceridemia increased from 23.58%at the initiation of treatment to 35.53%at 5 years of cART,with hypertriglyceridemia(TG)being the main contributor to the increase,and the non-nucleoside reverse transcriptase inhibitor and protease inhibitor regimens changed significantly at 1 year of cART(P＜0.017).There was no significant change in the incidence of hypercholesterolemia and ow-density lipoprotein cholesterol(P＞0.017).The incidence of low HDL-C decreased from 45.28%at the initiation of treatment to 11.32%at 5 years of cART,and the change in the incidence at 1 year of cART was significant(P＜0.05).The results of multivariate analysis showed that smoking,body mass index＞25 kg/m2,and tenofovir lamivudine and lopinavir ritonavir regimens were risk factors for the development of hyperlipidemia(P＜0.05).The Framingham score did not show a significant change in the 10-year cardiovascular risk of PLWH during 5 years with cART.Conclusions The changes in blood lipids in PLWH during the 5-year cART were mainly manifested by the increase in the incidence of hypertriglyceridemia and the decrease in the incidence of low HDL-C,which changed significantly at 1 year of cART.Individuals who smoke,have a body mass index greater than 25 kg/m2,and use enofovir+lamivudine+lopinavir/ritonavir regimens are prone to hyperlipidemia and should be monitored for lipids.Five years of cART had no significant effect on the 10-year risk of cardiovascular disease in PLWH.