Lipid profile dynamics and associated cardiovascular disease risk indices in Chinese people living with human immunodeficiency virus receiving antiretroviral therapy

Dyslipidemia is one of the leading contributing factors to HIV-related cardiovascular disease (CVD). In China, data regarding the dynamic changes in lipid profiles and dyslipidemia among people living with HIV (PLWH) receiving long-term antiretroviral therapy (ART) remain scarce, especially in Jiangxi Province. Therefore, this study aimed to longitudinally analyze the changes in lipid profiles and dyslipidemia among PLWH in Nanchang City and evaluated composite metabolic indices to assess the future CVD risk. Demographic data and clinical parameters were collected. The risk factors and longitudinal changes in lipid profiles and composite metabolic indices associated with HIV infection and ART were analyzed using mixed-effects models and generalized estimating equations. The definition of dyslipidemia was made based on the Chinese Guidelines for Lipid Management (2023). The study included 417 participants of whom 356 were male. Their mean age at baseline was 46.90 ± 15.84 years. The overall prevalence of dyslipidemia was 58.51% at enrollment and rose to 73.62% after 5 years of ART, with high TG and high TC as the most common abnormalities. Across all ART regimens, the proportion of patients with abnormally elevated TG and TC levels increased significantly over time after ART initiation (all P < 0.05). The lopinavir/ritonavir (LPV/r) + lamivudine (3TC) + zidovudine (AZT) regimen exhibited the most pronounced associations with increased risks of these lipid abnormalities. The proportion of individuals with severe elevations in atherogenic index of plasma (AIP) and those in the 4th quartile of the triglyceride-glucose (TyG) index increased significantly over the follow-up period (both P < 0.05). The prevalence of dyslipidemia was notably high in PLWH receiving ART in Jiangxi Province, with the lipid profiles of most patients exhibiting significant changes within the first 3 months of ART initiation. This finding highlights the importance of implementing early lipid monitoring and selecting lipid-friendly ART regimens for this population. Furthermore, the AIP and the TyG index should be advocated for use starting from the initiation of ART to dynamically assess and stratify CVD risk during follow-up.