Association between low-density lipoprotein cholesterol with cholelithiasis among hospitalized people living with HIV: a retrospective case-control study

Abstract Objective To investigate the association between low-density lipoprotein cholesterol (LDL-C) levels and cholelithiasis among hospitalized people living with HIV. Methods We conducted a single-center retrospective case-control study including 259 hospitalized people living with HIV admitted between January 2019 and January 2025. The case group comprised 98 patients with imaging-confirmed cholelithiasis, and the control group comprised 161 patients without imaging evidence of cholelithiasis during the same period. Demographic characteristics, co-infections, antiretroviral therapy-related variables, and laboratory parameters were collected. Logistic regression models were used to evaluate the association between LDL-C and cholelithiasis. Model I was adjusted for sex, age, and body mass index (BMI), and Model II was further adjusted for hepatitis B virus (HBV) co-infection, duration since confirmed HIV diagnosis, albuvirtide (ABT) treatment, and CD4 + T-cell count. Smooth-curve fitting and segmented regression were used to explore a potential nonlinear association. Stratified analyses and interaction tests were conducted as exploratory analyses. Results Compared with controls, patients with cholelithiasis were younger (50.22 ± 11.71 vs. 56.30 ± 16.00 years) and more likely to be female (40.82% vs. 6.21%). BMI was similar between groups. The case group had higher total cholesterol, high-density lipoprotein cholesterol, and LDL-C levels than the control group, with mean LDL-C levels of 3.08 ± 0.96 mmol/L and 2.42 ± 0.75 mmol/L, respectively. In univariable analysis, LDL-C was significantly associated with cholelithiasis (OR = 2.54, 95% CI: 1.80–3.58; P < 0.001). This association remained significant after multivariable adjustment (Model II: OR = 2.71, 95% CI: 1.79–4.11; P < 0.001). Smooth-curve fitting suggested a nonlinear association, with an exploratory inflection point at 2.28 mmol/L. Below this threshold, the association was not statistically significant; above it, the positive association was substantially stronger. No significant interaction was observed for HBV or ABT. Conclusion Among hospitalized people living with HIV, elevated LDL-C was independently associated with cholelithiasis. The data also suggest a possible nonlinear association, with a stronger effect above 2.28 mmol/L. These findings may help identify metabolic risk factors for cholelithiasis in this population, but confirmation in larger prospective studies is required.