Elevated high-sensitivity C-reactive protein and triglycerides in people with HIV treated with lipid-lowering therapy

People with HIV (PWH) have an increased risk of cardiovascular disease, and many receive lipid-lowering therapy (LLT). However, it is unknown if PWH treated with LLT remain at a higher residual cardiovascular risk than persons from the general population. We investigated the risk of elevated biomarkers of inflammation and dyslipidemia associated with cardiovascular disease, among PWH and controls receiving LLT.

In this cross-sectional study, we included PWH from the Copenhagen Comorbidity in HIV infection (COCOMO) study and population controls from the Copenhagen General Population Study (CGPS), frequency matched 1 : 4 on age and sex. Among these, 142 PWH and 428 controls reported current treatment with LLT and were included in the analysis.

We used multivariable logistic regression models to assess the association between HIV and biomarkers including high-sensitivity C-reactive protein (hs-CRP) ≥3.0 mg/l, low-density lipoprotein cholesterol (LDL-C) ≥2.6 mmol/l, and triglycerides (TG) ≥2.26 mmol/l combined with high-density lipoprotein cholesterol (HDL-C) ≤1.03 mmol/l.

PWH had a higher risk of elevated hs-CRP [adjusted odds ratio (aOR) 1.97 [1.17-3.32], P   =  0.01] and of elevated TG (aOR 3.36 [1.94-5.81], P  < 0.01). No difference according to LDL-C risk was found. Our findings remained robust in sensitivity analyses adjusting for SCORE2 category, physical activity and exposure to thymidine analogues, and in subgroup analyses by antiretroviral therapy regimen, except for hs-CRP among PWH on protease inhibitor-based regimens.

PWH receiving LLT had higher risk of elevated hs-CRP and TG compared to controls. This warrants increased attention and monitoring of treatment goals in PWH receiving LLT.