Early Warning and Behavioural Intervention on the Cardiovascular Disease Risk in People Living with HIV: A Multicentre Non-Randomized Controlled Trial.

introductionHuman Immunodeficiency Virus (HIV) infection has currently become a manageable chronic disease with the prevalence of antiretroviral therapy (ART). The increase in life expectancy and the rising number of people aged more than 50 years among people living with HIV (PLWH) both indicate an increasing risk of chronic non-communicable diseases, especially cardiovascular disease (CVD). Moreover, the contribution of traditional risk factors to CVD far outweighs that of HIV-related factors, which indicates that interventions for reducing CVD risk factors in PLWH are urgent.

methodsWe designed a multicentre non-randomized controlled trial (nRCT), which incorporated six acquired immunodeficiency syndrome (AIDS)-designated hospitals in Zhejiang Province, and three rounds of surveys were conducted from January 2023 to January 2024. Assessments were performed at baseline, 3 months and 6 months post-intervention, respectively. For the intervention group, PLWH were informed of their 5/10-year CVD risk, on the basis of the assessment in baseline, verbally or online to warn them of the risk of having CVD; at the same time, personalized risky behaviour reinforcement intervention was implemented face-to-face or online for about 15 min. For the control group, PLWH were not informed of the 5/10-year CVD risk and only received routine health education in the clinic without additional intervention. Intervention effects were assessed using 5/10-year CVD risk, health-related behaviours (e.g., smoking, alcohol consumption, physical activities and dietary nutrition), as well as CVD cognitive level. To minimize baseline differences and reduce confounding due to non-treatment factors (e.g., socio-demographic characteristics), propensity score matching (PSM) was applied to construct comparable intervention and control groups, and a generalized estimating equation (GEE) was used to estimate the effect of the intervention. This trial was retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500112178) on 11 November 2025.

resultsA total of 948 PLWH were incorporated at baseline, after excluding ineligible participants, including 494 in the intervention group and 454 in the control group. The average age was 42.08 ( ± 11.94) years, with 826 male patients (87.13%). A total of 362 pairs were successfully matched after PSM. After matching, no statistical differences remained between the two groups. After 6 months' intervention, the intervention group showed significant improvements in CVD cognitive level, with a total increase of 2.30 points compared with 0.41 points in the control group (P = 0.028). Additionally, PLWH who almost never drink and have > 8 h of sedentary time per day, increased and decreased 4.54% and 1.46% respectively, compared with the control group (P < 0.05). The 10-year CVD risk decreased by 0.63% in the intervention group and 0.18% in the control group. Moreover, the smoking rate and drinking rate decreased more in the intervention group compared with the control group, and the physical exercise compliance rate increased more as well, though there was no statistical difference compared with the control group (P > 0.05).

conclusionsRisk warning and behavioural intervention effectively improved CVD cognitive level. Although the risk warning and behavioural intervention could not make PLWH completely quit smoking or using alcohol, the intervention led to notable improvements in reducing the frequency of some health risk behaviours.