Hyperlipidemia and associated risk factors among people living with HIV on antiretroviral therapy: a retrospective cohort study from Eastern China

Objective: To determine the incidence of hyperlipidemia and identify its associated risk factors among people living with HIV (PLWH) initiating antiretroviral therapy (ART) in Eastern China, with the aim of informing strategies for early identification and timely management. Methods: We conducted a retrospective cohort study of PLWH who initiated antiretroviral therapy (ART) in Zhejiang Province from January 2019 to December 2021. Demographic characteristics, clinical details, and other relevant factors were retrieved from the National Free ART Database. Results: A total of 4387 PLWH were observed, with an incidence of hyperlipidemia of 43.8/100 person-years. A higher baseline CD4 cell count was associated with a reduced risk of hyperlipidemia: 51-200 cells/μL (aHR 0.75, 95% CI 0.65,0.87), 201-500 cells/μL (aHR 0.67, 95% CI 0.58,0.78), 501+ cells/μL (aHR 0.70, 95%CI 0.58, 0.84). Zidovudine + lamivudine + efavirenz, tenofovir disoproxil fumarate + lamivudine + lopinavir/ritonavir, elvitegravir/cobicistat/emtricitabine/ tenofovir alafenamide had a higher risk of hyperlipidemia. An HIV load ≥1000 copies/mL (aHR 4.03, 95% CI 3.67,4.42) was linked to an increased risk of hyperlipidemia. Conclusions: A high incidence of hyperlipidemia was observed in PLWH receiving ART. Strengthening blood lipid monitoring and managing modifiable risk factors are essential to prevent hyperlipidemia in PLWH.