Achievement of LDL cholesterol targets in HIV-positive patients: a single center cohort study

Background and aims: People living with HIV (PLWH) face an increased CardioVascular (CV) risk due to the interaction between risk factors, chronic inflammation and AntiRetroviral Therapies (ART) metabolic effects. However, standard risk models often underestimate this burden. Our study aims to evaluate: (i) the CV risk category and the relative LDL-C targets; (ii) the achievement of these targets; and (iii) factors associated with target achievement and HIV-related variables. Methods and results: A retrospective analysis was conducted on 246 PLWH, aged ≥40, on ART followed at the Niguarda Hospital. Clinical and laboratory data were extracted from the hospital's electronic registries and ten-year CV risk was assessed using SCORE2. Only 27.2% of the analyzed cohort achieved the recommended LDL-C targets with further lower prevalence in patients in the “high” or “very high” risk categories. Patients who achieved their LDL-C target had a more favorable cardiovascular risk profile (LDL-C: 75.8 ± 18.1 vs 121.1 ± 33.4 mg/dL, p < 0.001; systolic blood pressure: 116.9 ± 12.4 vs 123.4 ± 15.7 mmHg, p = 0.001), and CV risk categories, being less frequently classified as high and very-high risk (20.8 vs 52.4%, p < 0.0001). No significant relation was found between LDL-C target achievement and HIV-specific variables. Conclusions: LDL-C target achievement remains suboptimal and may not reflect adequate cardiovascular risk control in PLWH, supporting the need for more aggressive and HIV-tailored prevention strategies.