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Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women

Jonathan V Todd1,2, Stephen R Cole1,2, David A Wohl1

  • 11 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina.

AIDS Patient Care and Stds
|November 1, 2017
PubMed

Insights

Statin use for cardiovascular disease prevention is low in women with HIV, even when indicated. HIV status did not significantly affect statin initiation, suggesting a need for more aggressive lipid management in this population.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Public Health

Background:

  • Antiretroviral therapy increases life expectancy for people with HIV, highlighting the need to manage comorbidities like cardiovascular disease.
  • Current guidelines recommend aggressive statin use for LDL cholesterol reduction, but uptake in people with HIV, particularly women, is unclear.

Purpose of the Study:

  • To assess statin initiation rates after an indication in HIV-seropositive and HIV-seronegative women.
  • To determine if HIV serostatus influences the time to statin initiation.
  • To evaluate the impact of current guidelines on statin eligibility in this population.

Main Methods:

  • Analysis of data from the Women's Interagency HIV Study (WIHS) from 2000 to 2014.
  • Calculation of cumulative incidence of statin use post-indication.
  • Use of weighted proportional hazards regression to compare statin initiation between HIV-seropositive and HIV-seronegative women.

Main Results:

  • Cumulative 5-year statin use after indication was low (38% in HIV-positive, 30% in HIV-negative women).
  • HIV serostatus did not significantly impact the time to statin initiation (Hazard Ratio: 0.94, 95% CI: 0.62-1.43).
  • Applying ACC/AHA guidelines identified more HIV-positive women needing statins (16% to 45%).

Conclusions:

  • Statin uptake remains suboptimal in women with HIV, irrespective of HIV status.
  • Current guidelines suggest a higher proportion of HIV-positive women could benefit from statins.
  • Clinicians should proactively manage dyslipidemia in HIV-positive women to prevent cardiovascular disease.

Keywords:
cardiovascular diseasehuman immunodeficiency virushydroxymethylglutaryl-CoA reductase inhibitorslipidsstatinswomen's health

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