Chronicling the Statin Gap in People with HIV

Despite heightened cardiovascular disease (CVD) risk, too few get drugs at appropriate dose, researchers say.

As patients living with HIV do so longer, thanks to antiretroviral therapy, they have a two-fold higher risk for atherosclerotic cardiovascular disease (ASCVD) compared to those who are HIV-negative.

Now, a study on August 8th by HIV Medicine suggests there may be an “under-utilization” of statin therapy among people with the virus. This so-called “statin gap,” which includes many with HIV being given lower doses of the drugs compared with uninfected individuals, may in fact be contributing to their increased risk for ASCVD.

Just 27.8% of the people with HIV in the study who had other indications for statin therapy (eg, elevated LDL) received an appropriate prescription for these drugs. This includes 19.5% who were administered statins at too low a dose.

Moreover, only 37.2% of those with HIV who met the criteria for ASCVD were given statin therapy, compared with more than 55% of uninfected infected study participants.

In all people living with HIV were 32% less likely to be prescribed a statin as needed than those who were HIV negative. Although the study did not attempt to identify the causes of “statin omission” in people living with HIV, prior research has highlighted the potential for drug-drug interactions between statins and antiretroviral therapy, with the latter known to increase serum concentrations of the latter, thus raising the risk for adverse events “significantly,” the researchers said.

“[The] presence of drug-drug interactions and contraindications did not account for the differences in prescribing observed,” wrote the researchers, who did not respond to a request for comment. “Given the known increased risk of ASCVD for people living with HIV and the safety of concomitant use of statins with newer antiretroviral therapies, improvement in appropriate statin selection and dosing rates is imperative to improve patient outcomes.”

The findings are based on an analysis of 1758 participants with an indication for statin therapy, 879 of whom were people living with HIV. The mean age of study participants was 57.2 years, and the majority were Black (89.7%) and male (63.8%).

“With the availability of newer antiretroviral drugs with fewer statin interactions, appropriate product selection and dose adjustment can allow for statin treatment in most patients,” the researchers wrote. “Given the increased risk of ASCVD in people living with HIV and the known benefit of statin therapy, overstated concerns for drug-drug interactions should not be a reason to withhold therapy from indicated patients.”

In other words, mind the “statin gap” in people living with HIV.