In Section 2.3, it is stated that “Dyslipidemia in PLWH typically presents as hypocholesterolemia with relatively lower high-density lipoprotein cholesterol (HDL-c) and higher triglyceride levels than controls [38–40], although some studies note lower or similar levels of triglycerides [41].”
This generalization is problematic. The dyslipidemia profile in PLWH is highly context-dependent, varying significantly with ART regimen, HIV disease stage, and population characteristics. The cited references [38-40] are from the pre- or early-ART era and may not reflect contemporary cohorts on modern INSTI-based regimens, which are associated with more favorable lipid profiles. The contradictory finding in reference [41] further underscores this heterogeneity.
So, my questions are here:
1. How do the authors reconcile the contradictory lipid profiles reported across studies, and what is the basis for selecting “hypocholesterolemia with high triglycerides” as the “typical” presentation in the modern ART era?
2. Given the substantial evolution of ART and its metabolic effects, does the generalization about a single “typical” dyslipidemia pattern risk oversimplifying a highly variable clinical reality, potentially misleading therapeutic strategies?