Paradoxical Lipid Patterns and Elevated Atherogenic Risk in HIV Patients on Antiretroviral Therapy from the Rivers State University Teaching Hospital, Nigeria

Abstract

Background: Human immunodeficiency virus (HIV) infection and antiretroviral therapy (ART) are associated with metabolic disturbances, including dyslipidaemia and increased cardiovascular risk. Aim: This study evaluated lipid profile alterations and atherogenic cardiovascular risk among HIV-positive patients receiving ART. Methods: A hospital-based cross-sectional study was conducted among 150 participants (90 HIV-positive on ART and 60 HIV-negative controls) at Rivers State University Teaching Hospital, Nigeria. Fasting lipid parameters were measured, and atherogenic indices, Castelli’s Risk Index I (CRI-I), Castelli’s Risk Index II (CRI-II), Atherogenic Index of Plasma (AIP), and Atherogenic Coefficient (AC)—were calculated. Results: HIV-positive participants had significantly higher total cholesterol (6.42 ± 0.68 vs 4.98 ± 0.55 mmol/L), triglycerides (2.36 ± 0.41 vs 1.52 ± 0.29 mmol/L), LDL-C (3.92 ± 0.64 vs 3.05 ± 0.58 mmol/L), and non-HDL cholesterol (5.47 ± 0.72 vs 3.64 ± 0.60 mmol/L), alongside significantly lower HDL-C levels (0.95 ± 0.21 vs 1.34 ± 0.25 mmol/L) (p < 0.001). Atherogenic indices were markedly elevated in HIV-positive individuals: CRI-I (7.02 ± 1.84 vs 3.82 ± 0.91), CRI-II (4.36 ± 1.21 vs 2.21 ± 0.74), AIP (0.42 ± 0.12 vs 0.08 ± 0.10), and AC (6.02 ± 1.75 vs 2.82 ± 0.88) (p < 0.001). Conclusion: HIV-positive patients on ART exhibit a classical atherogenic lipid profile characterized by elevated LDL-C and reduced HDL-C, alongside significantly increased atherogenic indices. These findings highlight the combined impact of HIV infection and ART on cardiovascular risk and support the integration of atherogenic indices into routine HIV care.