Statin Utilization Among Human-Immunodeficiency Virus (HIV)-Infected Individuals Based on the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guideline

Abstract

Background. There are limited data on statin utilization among HIV+ individuals in real-world settings using the new 2013 ACC/AHA blood cholesterol guideline. We aimed to determine the proportion of appropriate statin use based on this guideline in a large urban outpatient center. Methods. Chart review of 1087 HIV+ patients 40 years and over from the Washington University Virology Clinic was done from January 1 to December 31, 2015. Patients were classified according to the 4 statin benefit groups from the guideline: (1) those with clinical atherosclerotic cardiovascular disease (ASCVD); (2) those with primary hyperlipidemia (LDL-C ≥ 190 mg/dL); (3) individuals 40 to 75 years of age with diabetes and an LDL 70 to 189 mg/dL without ASCVD; and (4) those 40 to 75 years of age without ASCVD or diabetes, with LDL 70 to 189 mg/dL, and with a 10-year ASCVD risk of ≥ 7.5%. Factors that may influence receipt of statin were analyzed using the chi-square test, t-test, or the Wilcoxon rank-sum test when applicable. Results. The median age of patients was 51 years and the majority were male (71%), black (67%), receiving antiretroviral therapy (98%), had HIV RNA ≤ 20 copies/ ml (87%) and median CD4 count of 523 cells/μL. Overall, 450 (41%) patients had an indication for statin use, with the majority classified under group 4. However, only 160 (36%) were on statins, of whom 89% were on appropriate doses. The percentages of patients on statins were only 36%, 44%, 49%, and 30% for groups 1, 2, 3, and 4, respectively. There was no significant difference between those who were and were not on statins in terms of CD4 count and pill burden. The rates of ritonavir, cobicistat, and efavirenz use were also similar between the two groups. In group 4, however, those who had viral suppression were more likely to be prescribed a statin compared with those who had no viral suppression (95% vs. 87%, P = 0.031). Conclusion. Two-thirds of our patients were not prescribed statins despite a strong indication for it based on the new guideline. Our finding stresses the critical need to address this gap among HIV+ individuals. It also emphasizes the need to prioritize ASCVD prevention in the care of the aging HIV-infected population.