AUTHOR=Montes María Luisa , Busca Carmen , Martín-Torres Juan , Bernardino José Ignacio , Arnaiz de las Revillas Francisco , Martín-Carbonero Luz , Sánchez Villegas Jorge , Micán Rafael , Dalmau David , Arcos Maria Mar , López Sánchez María de la Villa , de Gea Alejandro , Ibarra Ugarte Sofía , Arribas José Ramón , González-García Juan 

TITLE=Triglyceride–glucose index and FIB-4 score in relation to cardiovascular disease risk among people with HIV: a retrospective cohort study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1638071

DOI=10.3389/fmed.2025.1638071

ISSN=2296-858X

ABSTRACT=BackgroundPeople with HIV (PWH) have a high risk of cardiovascular events (CVEs). We investigated the incidence of CVEs in PWH and the usefulness of combining hepatic steatosis/insulin resistance (HS-IR) and risk of liver fibrosis for the evaluation of cardiovascular risk in PWH.MethodsWe retrospectively analyzed 7,286 PWH from the prospective CoRIS cohort. We calculated the baseline triglyceride-glucose index (TyG) and FIB-4 index to assess HS-IR and risk of fibrosis, respectively, and evaluated persons with abnormal values for both indices. The primary outcome was the incidence of CVEs, defined as myocardial infarction, coronary disease, stroke, transient ischemic attack, peripheral arterial obstruction, and/or cardiovascular death. The association between HS-IR and risk of fibrosis and incidence of CVEs was assessed using a univariable and multivariable competing risk survival regression analysis.ResultsThe overall incidence of CVEs was 3.5 per 1,000 person-years. HS-IR and risk of fibrosis were significantly associated with an increased risk of CVEs. Individuals with HS-IR and risk of fibrosis experienced markedly more CVEs than those with normal values (10.6 vs. 1.4 per 1,000 person-years, p < 0.001). After correction for possible confounders and traditional cardiovascular risk factors, abnormal values for HS-IR and risk of fibrosis score were independently associated with CVEs of (HR, 2.21 [1.2–4.1]; p < 0.01).ConclusionHS-IR and risk of fibrosis before ART are associated with increased risk of CVEs in PWH. A combined risk assessment incorporating HS-IR and risk of fibrosis may improve cardiovascular risk stratification in this population. These readily accessible tools can facilitate early identification and intervention in high-risk individuals.