Abstract
As antiretroviral therapy (ART) prolongs lifespans, people with HIV (PWH) face a new syndemic: Cardiovascular-Kidney-Metabolic (CKM) syndrome. Yet CKM in PWH is poorly characterized. Inflammation, complex pharmacokinetic (PK) alterations, ART-associated metabolic effects, and gut dysbiosis amplify risk. Managing CKM increases medication burden, thereby heightening the risk of drug-drug interactions and adverse drug effects. Therefore, CKM in PWH represents an emerging clinical pharmacology priority. We outline gaps and challenges and call for CKM research in PWH.