ObjectiveTo characterize the distribution of voriconazole (VRC) trough concentrations (Ctrough), identify factors associated with VRC exposure in HIV-infected patients complicated by invasive fungal disease (IFD), and determine the Ctrough threshold associated with an increased risk of adverse drug reactions (ADRs).MethodsA retrospective study was conducted at the First Hospital of Changsha from 1 January 2021, to 31 December 2025. Univariate and multivariate analyses were performed to identify