LDL-C target achievement in people living with HIV: impact of combination lipid-lowering therapy. A retrospective cohort analysis.

IF 2.9 2区医学 Q3 IMMUNOLOGY

AIDS Pub Date : 2026-08-31 DOI:10.1097/QAD.0000000000004594

Marcella Manicardi, Jovana Milic, Giuseppe Esposito, Marianna Menozzi, Giuseppe Mancini, Gian Luca Cuomo, Lorenzo Benassi, Elisabetta Delmonte, Severino Ambrosio, Cristina Mussini, Giuseppe Boriani, Giovanni Guaraldi

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引用次数: 0

Abstract

Background: Real-world low-density lipoprotein cholesterol (LDL-C) target attainment remains low in people with HIV (PWH). Updated ESC/EAS 2025 guidelines underscore the need to reassess treatment patterns in clinical practice.

Methods: Retrospective observational longitudinal study including PWH ≥40 years, evaluated twice between 2020 and 2025 at the Modena HIV Metabolic Clinic, with complete laboratory and clinical follow-up data. Objective was to evaluate the real-world use and effectiveness of different lipid-lowering therapy (LLT) regimens in achieving guideline-based LDL-C targets.

Results: Among 588 PWH (71.8% male), median age was 60 years (IQR 56-64) and 97.4% had suppressed HIV viral load. According to cardiovascular (CV) risk classification, 29.3% were at moderate risk, 52% at high risk, 12.4% at very high risk and 6.3% at extreme risk. LDL-C target attainment increased from 19.6% at baseline to 28.8% at follow-up. Achievement rates declined with increasing CV risk. In multivariable analysis, combination LLT was the strongest predictor of LDL-C target attainment (odds ratio 5.7, 95% confidence interval 3.7-9.0, P < 0.0001), whereas statin dose escalation was not. Diabetes was also associated with greater odds of reaching LDL-C goals.

Conclusions: LDL-C control remains suboptimal in PWH, particularly among those at higher cardiovascular risk. Combination lipid-lowering therapy markedly increases the likelihood of achieving LDL-C targets, supporting broader adoption of combination strategies in routine HIV care.

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HIV感染者LDL-C目标实现：联合降脂治疗的影响回顾性队列分析。

背景：现实世界中的低密度脂蛋白胆固醇（LDL-C）目标在HIV感染者（PWH）中仍然很低。更新后的ESC/EAS 2025指南强调了在临床实践中重新评估治疗模式的必要性。方法：回顾性观察性纵向研究，包括PWH≥40岁，于2020年至2025年在Modena HIV代谢诊所进行两次评估，并提供完整的实验室和临床随访数据。目的是评估不同降脂治疗（LLT）方案在实现基于指南的LDL-C目标方面的实际使用和有效性。结果：588名PWH患者中，男性占71.8%，中位年龄为60岁（IQR 56 ~ 64）， 97.4%的患者HIV病毒载量得到抑制。根据心血管（CV）危险分类，29.3%为中度危险，52%为高危，12.4%为极高危，6.3%为极端危险。LDL-C目标达到率从基线时的19.6%增加到随访时的28.8%。成就率随CV风险的增加而下降。在多变量分析中，联合LLT是LDL-C目标实现的最强预测因子（优势比5.7,95%置信区间3.7-9.0，P）。结论：PWH患者LDL-C控制仍然不够理想，特别是在心血管风险较高的患者中。联合降脂治疗显著增加了实现LDL-C目标的可能性，支持在常规HIV护理中更广泛地采用联合策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

AIDS 医学-病毒学

CiteScore

5.90

自引率

5.30%

发文量

478

审稿时长

3 months

期刊介绍： Publishing the very latest ground breaking research on HIV and AIDS. Read by all the top clinicians and researchers, AIDS has the highest impact of all AIDS-related journals. With 18 issues per year, AIDS guarantees the authoritative presentation of significant advances. The Editors, themselves noted international experts who know the demands of your work, are committed to making AIDS the most distinguished and innovative journal in the field. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.