Association of HIV infection with short-term major adverse cardiovascular events among Chinese patients with carotid atherosclerosis: a single-center retrospective cohort study

Background People living with HIV (PLWH) suffer accelerated atherosclerotic injury, but real-world Chinese cohort data excluding patients with pre-existing cardiovascular and cerebrovascular diseases remain scarce regarding HIV-related incident major adverse cardiovascular events (MACE). This study aimed to explore the independent associations between HIV infection and 2-year incident MACE among Chinese patients with carotid atherosclerosis free of prior cardiovascular events, and identify correlated metabolic and renal factors.Methods A retrospective single-center cohort design was adopted. We enrolled patients with ultrasound-confirmed carotid atherosclerosis from January 2020 to June 2023, excluded individuals with prior coronary heart disease, ischemic stroke or transient ischemic attack, and conducted standardized 2-year follow-up for all eligible participants. Univariate statistical tests screened variables correlated with MACE; variables with univariate p < 0.05 plus core clinical confounders (age, sex, hypertension, diabetes) were incorporated into multivariate binary logistic regression to identify independent correlates of new-onset MACE.Results Patients with HIV infection showed significantly younger age compared with HIV-negative counterparts (63.55 ± 10.81 years vs 70.61 ± 9.75 years, p < 0.001). The cumulative 2-year occurrence rate of MACE was markedly higher in the HIV-positive group (40.4% versus 22.9%, p = 0.023). Multivariate regression analysis verified four independent risk markers for incident MACE: HIV seropositivity (OR = 2.24, 95%CI 1.19–4.22, p = 0.012), baseline active smoking (OR = 1.98, 95%CI 1.07–3.66, p = 0.028), reduced estimated glomerular filtration rate (eGFR) (OR = 2.15, 95%CI 1.15–4.02, p = 0.017) and hyperuricemia (OR = 1.89, 95%CI 1.02–3.51, p = 0.043).Conclusion Chinese people living with HIV (PLWH) combined with carotid atherosclerosis develop atherosclerotic lesions at an earlier age and carry elevated short-term MACE risk. Integrated intervention strategies covering HIV viral control, smoking cessation, renal function protection and serum uric acid management can effectively improve cardiovascular long-term prognosis for this special population.