Related Experiment Video
Updated: Mar 21, 2026
An Affordable HIV-1 Drug Resistance Monitoring Method for Resource Limited Settings
Published on: March 30, 2014
Statin Utilization and Recommendations Among HIV- and HCV-infected Veterans: A Cohort Study
Meredith E Clement1, Lawrence P Park2, Ann Marie Navar3
1Division of Infectious Diseases, Duke University Duke Clinical Research Institute.
Insights
Statin therapy was underused in veterans with HIV and HCV infections. Updated cholesterol guidelines significantly increase statin recommendations, highlighting a gap in cardiovascular disease prevention for these populations.
Area of Science:
- Cardiology
- Infectious Diseases
- Public Health
Background:
- Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections increase cardiovascular disease (CVD) risk.
- The impact of updated cholesterol guidelines on statin use in veterans with HIV/HCV is not well understood.
Purpose of the Study:
- To evaluate statin use and recommendations in HIV-, HCV-, and HIV/HCV-coinfected veterans.
- To compare previous (ATP-III) with current (ACC/AHA, VA/DoD) cholesterol guidelines.
Main Methods:
- Retrospective cohort study of 13,579 HIV-, 169,767 HCV-, and 6,628 HIV/HCV-coinfected male veterans (aged 40-75).
- Analysis of laboratory, medication, and comorbidity data from 2008-2010.
- Comparison of statin eligibility and use under ATP-III versus current guidelines.
Main Results:
- Under ATP-III, 33.8%-50.6% had statin indications, but 22.7%-31.5% were undertreated.
- Current ACC/AHA and VA/DoD guidelines increased statin recommendations significantly across all groups.
- For HIV-infected veterans, recommendations rose from 50.6% (ATP-III) to 66.1% (ACC/AHA) and 57.3% (VA/DoD).
Conclusions:
- Statins were underutilized in HIV/HCV-infected veterans based on prior guidelines.
- Updated cholesterol guidelines substantially increase statin recommendations, widening the gap in underutilization.
- Addressing these gaps is crucial for improving CVD prevention in at-risk veteran populations.
Background:
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are associated with increased risk of cardiovascular disease (CVD). The potential impact of recently updated cholesterol guidelines on treatment of HIV- and HCV-infected veterans is unknown.
Methods:
We performed a retrospective cohort study to assess statin use and recommendations among 13 579 HIV-infected, 169 767 HCV-infected, and 6628 HIV/HCV-coinfected male veterans aged 40-75 years. Prior 2004 Adult Treatment Panel (ATP-III) guidelines were compared with current 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines and 2014 US Department of Veterans Affairs (VA)/US Department of Defense (DoD) joint clinical practice guidelines using laboratory, medication, and comorbidity data from the VA Clinical Case Registry from 2008 through 2010.
Results:
Using risk criteria delineated by the ATP-III guidelines, 50.6% of HIV-infected, 45.9% of HCV-infected, and 33.8% of HIV/HCV-coinfected veterans had an indication for statin therapy. However, among those eligible, 22.7%, 30.5%, and 31.5%, respectively, were not receiving ATP-III recommended statin therapy. When current cholesterol guidelines were applied by VA/DoD and ACC/AHA criteria, increases in recommendations for statins were found in all groups (57.3% and 66.1% of HIV-infected, 64.4% and 73.7% of HCV-infected, 49.1% and 58.5% of HIV/HCV-coinfected veterans recommended).
Conclusions:
Statins were underutilized among veterans infected with HIV, HCV, and HIV/HCV according to previous ATP-III guidelines. Current VA/DoD and ACC/AHA guidelines substantially expand statin recommendations and widen the gap of statin underutilization in all groups. These gaps in care present an opportunity to improve CVD prevention efforts in these at-risk populations.
