This population of middle-aged, clinically stable people with HIV and obesity in Lima-Callao, Peru presented a substantial burden of subclinical atherosclerosis and metabolic abnormalities despite low reported cardiovascular disease history, and cardiovascular risk estimates varied substantially across scores, with an HIV-specific score identifying a much higher proportion as high risk than general-population scores.
Key Findings
Results
Among 126 clinically stable people with HIV and obesity in Lima-Callao, Peru, clinical cardiovascular disease history was uncommon but subclinical carotid atherosclerosis was frequent.
Clinical cardiovascular disease history was reported in 2.4%.
Carotid Doppler ultrasound showed atherosclerotic changes (increased CIMT or carotid plaque) in 34.4%.
Carotid atherosclerotic changes were associated with older age and longer time on ART.
Cross-sectional study of people aged ≥35 years with BMI >30 kg/m² enrolled in 2024.
Results
Metabolic abnormalities were highly prevalent in the cohort.
Abnormal glucose metabolism was identified in 89.7%.
Dyslipidemia was present in 82.5%.
Metabolic syndrome was present in 50.8%.
Low apolipoprotein A1 was found in 22.6%.
Results
Elevated inflammatory markers were present in a subset of participants.
Elevated inflammatory markers were found in 28.2%.
Results
Almost no participants had entirely normal cardiometabolic findings.
Only 8.1% had normal findings across all evaluations.
Results
The proportion classified as high cardiovascular risk differed substantially by risk score, with the HIV-specific score classifying far more patients as high risk.
High cardiovascular risk was observed in 19.4% by Framingham.
High risk was observed in 9.4% by ACC/AHA.
High risk was observed in 75.4% by the HIV-CARDIO-PREDICT score.
Results
The study population was middle-aged, with long-term ART exposure and good HIV control, and obesity.
126 participants enrolled; 77.7% male; mean age 50.6 years.
Mean time on ART was 12.4 years; mean CD4 count 759.8 cells/µL; 97.6% had HIV-RNA <200 copies/µL.
Mean BMI was 34.0 kg/m².
What This Means
This study looked at 126 people living with HIV and obesity in Lima-Callao, Peru. Most were middle-aged men whose HIV was well controlled on long-term treatment. Very few (2.4%) reported a history of heart or blood vessel disease. However, ultrasound of the neck arteries showed early signs of artery disease (thicker artery walls or plaque) in about one in three people, especially those who were older or had been on HIV treatment longer.
Metabolic problems were very common: nearly 90% had abnormal blood sugar metabolism, over 80% had abnormal blood fats, and about half met criteria for metabolic syndrome. Only 8.1% had completely normal results across all tests. Estimates of heart disease risk differed widely depending on the tool used: 9.4% were high risk by one general-population score (ACC/AHA), 19.4% by another (Framingham), and 75.4% by an HIV-specific score.
This research suggests that people with HIV and obesity may carry a heavy hidden burden of heart and metabolic disease even when they feel well and have no history of such problems. It also suggests that general-population risk calculators may underestimate risk in this group, and the authors suggest that targeted screening and timely preventive care may help. Because the study was a one-time snapshot in a single region, it cannot show cause and effect.
Hidalgo J, Pinedo Y, Agurto E, Cárdenas L, Gómez de la Torre J, Ayarza R, et al.. (2026). High cardiometabolic burden among people with HIV and obesity in Peru.. HIV research & clinical practice. https://doi.org/10.1080/25787489.2026.2746807