Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 09 09 1 18 Yin’an Zhuang Department of Infectious Diseases, Zhanjiang Central People’s Hospital, Zhanjiang, Guangdong, China Jiufang Huang Health Examination Center, Zhanjiang Central People’s Hospital, Zhanjiang, Guangdong, China Zeng Pang Department of Infectious Diseases, Zhanjiang Central People’s Hospital, Zhanjiang, Guangdong, China Wenmin Lin Department of Infectious Diseases, Zhanjiang Central People’s Hospital, Zhanjiang, Guangdong, China 2026 05 10 2026 06 09 People living with HIV (PLWH) may experience metabolic and hepatic complications during long-term antiretroviral therapy (ART). This single-center retrospective study compared lipid profile changes and liver-related outcomes among PLWH receiving bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF), NNRTI-based regimens, or boosted protease inhibitor (PI)-based regimens, emphasizing metabolic and hepatic safety in routine clinical care. Between January 2024 and December 2025, 120 PLWH on ART were included and grouped by primary regimen: B/F/TAF (n=60), NNRTI-based regimens (n=30), and boosted PI-based regimens (n=30). Demographic and clinical variables, including HIV RNA, CD4+ T-cell counts, lipid parameters, and liver function indices, were collected. Outcomes included dyslipidemia, lipid changes, liver enzyme abnormalities, and liver-related adverse events. Between-group comparisons and exploratory multivariable logistic regression were performed. Baseline characteristics were similar across groups. During follow-up, dyslipidemia prevalence differed significantly (20.0%, 30.0%, and 50.0%, respectively), with hypertriglyceridemia occurring in 8.3%, 13.3%, and 30.0% of patients. Boosted PI users demonstrated greater increases in atherogenic lipid measures. Multivariable analysis indicated that boosted PI use, higher BMI, and baseline dyslipidemia were associated with higher dyslipidemia risk. Liver laboratory indices remained largely stable, and severe hepatotoxicity was uncommon. Liver enzyme abnormalities appeared more related to underlying conditions (e.g., fatty liver and viral hepatitis coinfection) than to ART regimen type. Overall, B/F/TAF showed relatively mild lipid changes, whereas boosted PI-based regimens were linked to higher dyslipidemia risk. Limitations include lack of systematic immune-recovery and inflammatory biomarker data; prospective studies incorporating these markers are needed. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4832 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4832/2418