Substantial Statin Treatment Gap Exists for People Living With HIV
Higher rates of cardiovascular disease (CVD) are well documented in people with HIV infection especially as they age, and using statin treatments with HIV regimens is generally safe and effective. However, in a presentation from a 12-year analysis of the large NA-ACCORD cohort at the 2017 Conference on Retroviruses and Opportunistic Infections, more than half of those who could use a statin to treat their CVD had not received a prescription for it.
Researchers looked at the medical records of more 86,000 people from Jan 2001 to Dec 2013. They used the ATP III Guidelines to assess whether a person was eligible to receive a statin prescription based upon various risk factors such as low and high density cholesterol, triglycerides, Framingham score, diabetes, CD4 counts, viral loads, AIDS diagnosis, age and smoking history. They included those individuals with no prescription at or within 6 months of the indication for a statin prescription.
From their analysis, a large treatment gap had emerged from all of those who were eligible for getting a prescription: between those who had received one (12%) and those who hadn't (88%). The good news is that the rate of statin prescriptions had increased 300% (6% to 18%) over time while the statin treatment gap had declined (73% to 53%). However, still more than 50% of those who could have been prescribed a statin had not received one throughout the 12 years of study.
Those who were less likely to get a statin despite possible benefits from using one were younger people (<40 years), African Americans, current smokers, those with low CD4 counts (<200) and those on a protease inhibitor regimen. Factors that increased the likelihood that a prescription was written included older age (>50 years), being white, MSM, without hepatitis C, higher CD4 counts and undetectable viral load.
These results point to the need for more attention during medical visits to assessing and using documented risk factors for guiding the prescription of statins in those who could benefit from using them.
KN Althoff, et al. The Large Gap Between Statin Eligibility and Prescription Among HIV+ in North America. 2017 CROI, Seattle. Abstract 619.