ORIGINAL RESEARCH article
Front. Med.
Sec. Infectious Diseases: Pathogenesis and Therapy
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1638071
Triglyceride–Glucose Index and FIB-4 Score in Relation to Cardiovascular Disease Risk among People with HIV: A Retrospective Cohort Study
Provisionally accepted
Maria Luisa Montes Ramirez1*
Carmen Busca Arenzana1
Juan Martín-Torres2
Jose I Bernardino1Francisco Arnaiz de las Revillas3Luz Martín-Carbonero1Jorge Sánchez Villegas4Rafael Micán1David Dalmau5Maria Mar Arcos1María de la Villa López-Sánchez6Alejandro de Gea1Sofía Ibarra Ugarte7
Jose Arribas1Juan González-García1- 1Unidad VIH, Servicio Medicina Interna, Hospital Universitario La Paz, Madrid, Spain
- 2Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain, Madrid, Spain
- 3Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain, Santander, Spain
- 4Enfermedades Infecciosas, Hospital Universitario Virgen de la Macarena, Sevilla, Spain, Seville, Spain
- 5Unidad VIH/ITS/PrEP, Hospital Universitari Mutua Terrassa, Barcelona, Spain, Barcelona, Spain
- 6Unidad de Enfermedades Infecciosas, Hospital Universitario de Jaén, Jaén, Spain
- 7Hospital Universitario Basurto, Bilbao, Spain
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Background People 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. Methods We 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. Results The 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). Conclusion HS-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.
Keywords: HIV, cardiovascular events, hepatic steatosis 3, liver fibrosis, MASLD
Received: 30 May 2025; Accepted: 29 Sep 2025.
Copyright: © 2025 Montes Ramirez, Busca Arenzana, Martín-Torres, Bernardino, Arnaiz de las Revillas, Martín-Carbonero, Sánchez Villegas, Micán, Dalmau, Arcos, López-Sánchez, de Gea, Ibarra Ugarte, Arribas and González-García. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Maria Luisa Montes Ramirez, mmontesr2001@yahoo.es
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