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. 2017 Nov;31(11):447-454.
doi: 10.1089/apc.2017.0145.

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

Jonathan V Todd  1   2 , Stephen R Cole  1   2 , David A Wohl  1 , Ross J Simpson Jr  3 , Michele Jonsson Funk  2 , M Alan Brookhart  2 , Jennifer Cocohoba  4 , Daniel Merenstein  5 , Anjali Sharma  6 , Jason Lazar  7 , Joel Milam  8 , Mardge Cohen  9 , Stephen Gange  10 , Tené T Lewis  11 , Greer Burkholder  12 , Adaora A Adimora  1   2
Affiliations

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

Jonathan V Todd et al. AIDS Patient Care STDS. 2017 Nov.

Abstract

Increased life expectancy of persons living with HIV infection receiving antiretroviral therapy heightens the importance of preventing and treating chronic comorbidities such as cardiovascular disease. While guidelines have increasingly advocated more aggressive use of statins for low-density lipoprotein (LDL) cholesterol reduction, it is unclear whether people with HIV, especially women, are receiving statins when indicated, and whether their HIV disease is a factor in access. We assessed the cumulative incidence of statin use after an indication in the Women's Interagency HIV Study (WIHS), from 2000 to 2014. Additionally, we used weighted proportional hazards regression to estimate the effect of HIV serostatus on the time to initiation of a statin after an indication. Cumulative incidence of statin use 5 years after an indication was low: 38% in HIV-seropositive women and 30% in HIV-seronegative women. Compared to HIV-seronegative women, the weighted hazard ratio for initiation of a statin for HIV-seropositive women over 5 years was 0.94 [95% confidence interval (CI) 0.62, 1.43]. Applying the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines increased the proportion of HIV-seropositive women with a statin indication from 16% to 45%. Clinicians treating HIV-seropositive women should consider more aggressive management of the dyslipidemia often found in this population.

Keywords: cardiovascular disease; human immunodeficiency virus; hydroxymethylglutaryl-CoA reductase inhibitors; lipids; statins; women's health.

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Conflict of interest statement

M.J.F. is a member of the Scientific Steering Committee (SSC) for a postapproval safety study funded by GlaxoSmithKline, and receives salary support through a contract with AstraZeneca. G.B. has research support from Amgen, Inc., Bristol-Myers Squibb, and has consulted for Definicare, LLC. All other authors have no potential conflicts of interest to disclose.

Figures

<b>FIG. 1.</b>
FIG. 1.
Cohort flow diagram.
<b>FIG. 2.</b>
FIG. 2.
Cumulative incidence of statin initiation after an indication for statin use. (A) Unadjusted. (B) Weighted.
<b>FIG. 3.</b>
FIG. 3.
Statin indication by age and changing guidelines.
See this image and copyright information in PMC

References

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