Optimizing Cardiovascular Risk in PLWH: Real-World Efficacy and Lipid Kinetics of Fixed-Dose Combination Rosuvastatin Ezetimibe

Background: People living with HIV (PLWH) have increased cardiovascular disease (CVD) risk, and dyslipidemia remains a major modifiable factor. Achieving recommended low-density lipoprotein cholesterol (LDL-C) targets can be challenging. Objective: To evaluate the real-world effectiveness and safety of fixed-dose low-dose rosuvastatin/ezetimibe in virologically stable PLWH and explore lipid-lowering kinetics versus an unmatched HIV-negative control cohort. Methods: This retrospective single-center study included 32 PLWH and 43 HIV-negative outpatients receiving rosuvastatin 5 mg plus ezetimibe 10 mg daily. Lipid parameters, CVD risk scores, and safety markers were assessed at baseline, 3 months, and 6 months. Results: In PLWH, LDL-C decreased from 170.7 ± 35.1 to 87.8 ± 24.6 mg/dL at 6 months (p< 0.001), and 53.1% reached guideline-recommended LDL targets. CVD risk scores improved and correlated with LDL-C reduction (D:A:D, r=0.74). Mixed-design ANOVA showed significant group×time interactions for total, LDL, and non-HDL cholesterol: controls achieved most lipid reduction by 3 months, whereas PLWH showed a more progressive decline through 6 months. No treatment-limiting adverse events or viro-immunological deterioration occurred. Conclusions: The combination of low-dose rosuvastatin and ezetimibe proved safe and effective in enhancing lipid profiles and lowering cardiovascular risk in PLWH, including those with metabolic comorbidities. This strategy facilitates achievement of stringent lipid targets outlined in current HIV guidelines, by delivering synergistic LDL reductions, superior to statin monotherapy. The exploratory comparison suggests distinct lipid-lowering kinetics in PLWH versus HIV-negative controls; demographic differences between cohorts warrant cautious interpretation.