Optimizing Cardiovascular Risk in PLWH: Real-World Efficacy and Lipid Kinetics of Fixed-Dose Combination Rosuvastatin Ezetimibe

Background: People living with HIV (PLWH) have increased cardiovascular disease risk, and dyslipidemia remains a major modifiable factor. Achieving recommended low-density lipoprotein cholesterol (LDL-C) targets can be challenging. Objective: To evaluate the real-world effectiveness and safety of fixed-dose low-dose rosuvastatin/ezetimibe in virologically stable PLWH and to describe lipid-lowering kinetics in comparison with an HIV-negative control cohort. Methods: This retrospective single-center study included 32 PLWH and 43 HIV-negative outpatients receiving rosuvastatin 5 mg plus ezetimibe 10 mg daily. Lipid parameters, cardiovascular risk scores, and safety markers were assessed at baseline, 3 months, and 6 months. Results: In PLWH, LDL-C decreased from 170.7 ± 35.1 to 87.8 ± 24.6 mg/dL at 6 months, corresponding to a mean reduction of 46.7% (p < 0.001). Total cholesterol and non-HDL cholesterol also decreased significantly (p < 0.001 for both), while triglycerides decreased significantly at month 6 (p = 0.016). Overall, 53.1% of PLWH reached guideline-recommended LDL-C targets. Both the 5-year and 10-year D:A:D scores decreased significantly during follow-up (p < 0.001 for both). The exploratory comparison suggested a more rapid early lipid response among HIV-negative controls, with most of the reduction occurring by month 3. No treatment-limiting adverse events or viro-immunological deterioration occurred. Conclusions: Low-dose rosuvastatin combined with ezetimibe was associated with substantial improvement in atherogenic lipid parameters in virologically stable PLWH, while the exploratory finding of an earlier response among HIV-negative controls may support further investigation of treatment-response kinetics.