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Observational Study
. 2025 Nov 6;81(4):818-826.
doi: 10.1093/cid/ciaf207.

Incidence of Statin Initiation Among People With and Without HIV in the United States: A Prospective Observational Study

Tiffany L Breger  1 , Daniel J Westreich  2 , Andrew Edmonds  2 , Jessie K Edwards  2 , Stephen R Cole  2 , Catalina Ramirez  1 , Alicia E Diggs  3 , Igho Ofotokun  4 , Seble G Kassaye  5 , Todd T Brown  6 , Deborah Konkle-Parker  7 , Frank J Palella  8 , Sarah Krier  9 , Deborah L Jones  10 , Gypsyamber D'Souza  11 , Mardge H Cohen  12 , Phyllis C Tien  13 , Tonya N Taylor  14 , Kathryn Anastos  15 , Alan L Hinderliter  1 , Joseph J Eron  1 , M Bradley Drummond  1 , Michelle A Floris-Moore  1
Affiliations
Observational Study

Incidence of Statin Initiation Among People With and Without HIV in the United States: A Prospective Observational Study

Tiffany L Breger et al. Clin Infect Dis. .

Abstract

Background: To reduce atherosclerotic cardiovascular disease (ASCVD) among US people with human immunodeficiency virus (HIV, PWH), it is critical to assess shortfalls in statin initiation. We aimed to describe patterns in clinically indicated statin initiation among demographically similar people with or at increased vulnerability to HIV.

Methods: Using data from the Multicenter AIDS Cohort Study and Women's Interagency HIV Study, we followed 842 men and 852 women with an indication for statin use based on 2013 American College of Cardiology/American Heart Association guidelines for statin initiation between January 2014 and March 2020. We estimated 2-year incidence of statin initiation stratified by demographic, clinical, and behavioral characteristics and compared estimates using incidence differences.

Results: Within 2 years of statin indication, 20% of participants reported statin use. Initiation of statin therapy did not differ significantly by HIV status. However, initiation was lower among Black versus non-Black persons, especially among men (14.0% versus 22.3%; difference, -8.3%; 95% confidence interval, -13.8% to -2.8%). Compared with initiation among persons indicated based only on ≥7.5% 10-year predicted ASCVD risk (incidence: men, 14.2%; women, 15.2%), initiation was higher among those with existing ASCVD (incidence: men, 32.9%; women, 22.0%) or diabetes (incidence: men, 26.4%; women, 24.5%). Initiation was lower among current versus noncurrent smokers and higher among those with comorbidities.

Conclusions: Guideline-driven statin initiation was low, with large inequities by race. With indications for statin use expanding for PWH, redressing barriers to guideline implementation will be crucial to achieving improved outcomes through uptake of these evidence-based therapies.

Keywords: HIV; cardiovascular disease; cohort studies; statins.

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Conflict of interest statement

Potential conflicts of interest. D. J. W. has received personal fees for consulting from Sanofi-Pasteur on unrelated topics. T. T. B. has served as a consultant to ViiV Healthcare, Janssen, EMD-Serono, and Merck. F. J. P. has served as a consultant and/or speaker for ViiV Healthcare, Gilead, Janssen, EMD-Serono, and Merck. M. B. D. is supported by U01-HL146194. M. A. F. M. has received consulting fees (for participation on an advisory board) from ViiV Healthcare. All other authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

    1. Shah ASV, Stelzle D, Lee KK, et al. Global burden of atherosclerotic cardiovascular disease in people living with HIV: systematic review and meta-analysis. Circulation 2018; 138:1100–12. - PMC - PubMed
    1. Rosenson RS, Hubbard D, Monda KL, et al. Excess risk for atherosclerotic cardiovascular outcomes among US adults with HIV in the current era. J Am Heart Assoc 2020; 9:e013744. - PMC - PubMed
    1. Wong C, Gange SJ, Moore RD, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clin Infect Dis 2018; 66:1230–8. - PMC - PubMed
    1. Muiruri C, Longenecker CT, Meissner EG, et al. Prevention of cardiovascular disease for historically marginalized racial and ethnic groups living with HIV: a narrative review of the literature. Prog Cardiovasc Dis 2020; 63:142–8. - PMC - PubMed
    1. National Academies of Sciences, Engineering, and MedicineHealth and Medicine DivisionBoard on Population Health and Public Health PracticeCommittee on Community-Based Solutions to Promote Health Equity in the United States . The state of health disparities in the United States. In: Baciu A, Negussie Y, Geller A, Weinstein JN, eds. Communities in action: pathways to health equity. Washington, DC: The National Academies Press, 2017:57–98. - PubMed

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