The analysis involved 1,085 HIV-positive people at least 40 years old who visited the clinic during 2015.
The research team classified participants into four statin benefit groups as specified in ACC/AHA guidelines: (1) clinical ASCVD; (2) primary hyperlipidemia (LDL-C ≥ 190 mg/dL); (3) 40 to 75 years old with diabetes and LDL-C 70 to 189 mg/dL without ASCVD; or (4) 40 to 75 years old without ASCVD or diabetes, with LDL-C 70 to 189 mg/dL, and with a 10-year ASCVD risk of ≥ 7.5%.
The study group averaged 51.9 years in age; 71% of participants were men, 68% were black, and 98% were on antiretroviral therapy, with 86% having an undetectable viral load.
Researchers found that among 1,085 participants, 450 (41%) had a statin indication by ACC/AHA criteria. However, only 161 of those 450 people (36%) had a statin prescription, including 36% in group 1, 44% in group 2, 49% in group 3, and 29% in group 4.
Among participants with a statin prescription, the proportion of people prescribed high-dose statins were 30% in group 1, 75% in group 2, 29% in group 3, and 21% in group 4.
Compared with patients not prescribed statins, those prescribed a statin had a higher median CD4 count (630 versus 573 cells/mm3, P = 0.050) and a marginally higher rate of viral suppression (93% versus 88%, P = 0.073). In indication group 4, a significantly higher proportion of people with a statin prescription had viral suppression (95% versus 87%, P = 0.031).
Statin users did not differ significantly from nonusers in the following: proportion of people taking five or more antiretrovirals; median number of total medications; or proportion of people taking an HIV agent that may interact with statins (namely ritonavir [Norvir], cobicistat, or efavirenz [Sustiva]).
The researchers conclude that "two thirds of our patients were not prescribed statins despite a strong indication ... based on the new [ACC/AHA] guidelines." The investigators surmised that HIV providers may not routinely consult ACC/AHA guidelines.