Achievement of LDL cholesterol targets in HIV-positive patients

Abstract

Background and objectives: People living with HIV (PLWH) face an increased cardiovascular (CV) risk due to the interaction of traditional risk factors, chronic inflammation and cumulative antiretroviral therapy (ART) adverse metabolic effects. However, standard risk models often underestimate this burden, limiting effective prevention. This study evaluates LDL cholesterol target achivement in PLWH, based on European Society of Cardiology guidelines, and explores its association with clinical, immunological, and therapeutic HIV-related variables.
Methods: A retrospective analysis was conducted on 246 HIV-positive patients, aged ≥40, on ART at Niguarda Hospital. Clinical, laboratory, and therapeutic data were extracted from the hospital’s electronic registries, while ten-year CV risk was assessed using SCORE2 from which each patients LDL cholesterol target was defined.
Results: Only 27.2% of the analyzed cohort achieved the recommended LDL cholesterol targets; a significantly higher prevalence of uncontrolled profiles was observed among patients belonging to the “high” or “very high” SCORE2 risk categories (29.3 and 14.6% of the population, respectively). 35.4% of the patients take statins, 12.2% ezetimibe while only the l’11.4% take their association. Univariate analysis showed that lower value of total cholesterol (r=-0.490, p<0.0001), triglycerides (r=-0.188, p=0.003), systolic blood pressure (r=-0.190, p=0.003), and SCORE2 risk class (r=0.270, p<0.0001) were significantly associated with an increased likelihood of achieving the LDL cholesterol target, whereas no significant relation was found with HIV-specific variables.
Conclusions: LDL cholesterol target achievement in PLWH remains suboptimal. A refined predictive model integrating HIV-specific variables, could be useful to enhance individualized risk stratification and to optimize therapeutic strategies tailored to PLWH.