In a Large HIV Group, Only 36% of Those Needing Statins Received Statins

Among 450 HIV-positive people with a statin indication by current guidelines, only 161 (36%) received a statin in an analysis of 1,085 people at a St. Louis HIV clinic. Potential statin-antiretroviral interactions did not explain low statin use.

Appropriate statin therapy curbs the risk of atherosclerotic cardiovascular disease (ASCVD), which poses a continuing threat to people living with HIV. Research has shown that HIV-positive populations eligible for statins by older Adult Treatment Panel (ATP) III guidelines often did not receive these drugs. Clinicians at Washington University, St. Louis, conducted a retrospective analysis to determine how many of their HIV-positive patients who were eligible for statins by 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines took statins.

The analysis focused on 1,085 HIV-positive people at least 40 years old and in care at the Washington University Virology Clinic from January through December 2015. Researchers classified them into four statin-benefit groups:

1. Clinical ASCVD.

2. Primary hyperlipidemia: low-density lipoprotein (LDL) cholesterol at or above 190 mg/dL.

3. 40 to 75 years old without ASCVD but with diabetes and LDL 70 to 189 mg/dL.

4. 40 to 75 years old without ASCVD or diabetes, with LDL 70 to 189 mg/dL, and with 10-year ASCVD risk at or above 7.5%.

The 1,085 study participants averaged 51.9 years in age; 71% were men, and 68% were black. Almost everyone (98%) was taking antiretroviral therapy, and 86% had an undetectable viral load. Most people (56%) had hypertension, while 16% had diabetes, and 9% had chronic kidney disease. Almost half (45%) smoked.

Of the 1,085 people analyzed, 450 (41%) had a statin indication, including 121 (27%) in group 1, 9 (2%) in group 2, 107 (24%) in group 3, and 213 (47%) in group 4. Of those 450 people needing a statin by 2013 ACC/AHA guidelines, only 161 (36%) took a statin, including 36% in group 1, 44% in group 2, 49% in group 3, and 29% in group 4. Proportions of people taking more effective high-dose statins were 30% in group 1, 75% in group 2, 29% in group 3, and 21% in group 4.

Compared with people not taking a statin, those who did had a higher median CD4 count (630 versus 537 cells/mm³, P = .050) and a trend toward a higher HIV suppression rate (93% versus 88%, P = .073). However, statin users did not differ from nonusers in rates of chronic kidney disease or end-stage renal disease, in proportion taking more than five antiretrovirals, in median number of total medications, or in use of antiretrovirals that may interact with statins (ritonavir [Norvir], cobicistat [Tybost], efavirenz [Sustiva, Stocrin]).

The Washington University team surmised that inconsistent use of ACC/AHA guidelines by HIV clinicians explains the gap in statin prescribing. They underline "a need to prioritize ASCVD prevention in the care of the aging HIV-infected population."