Statin Use Examined Among HIV Patients in Real-World Settings
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SAN DIEGO—Despite having a strong indication for statin-based therapy according to the 2013 ACA/AHA blood cholesterol guidelines, two-thirds of HIV+ patients were not prescribed appropriate therapy, according to a study presented at IDWeek 2017.
During the study, the authors reviewed charts of 1,087 HIV+ patients ≥40 years old from the Washington University Virology Clinic, a large urban outpatient center. Lemuel Nom, MD, of the Washington University School of Medicine, Saint Louis, MO, explained, “Patients were classified according to the 4 statin benefit groups from the guideline: one, those with clinical atherosclerotic cardiovascular disease (ASCVD); two, those with primary hyperlipidemia (LDL-C ≥190mg/dL); three, individuals 40 to 75 years of age with diabetes and an LDL 70 to 189mg/dL without ASCVD; and four, those 40 to 75 years of age without ASCVD or diabetes, with LDL 70 to 189mg/dL, and with a 10-year ASCVD risk of ≥7.5%.”
Of the patients included in the study, 67.6% were black and 31.4% were white. Additionally, 71.0% of patients were male, 98.3% were on antiretroviral therapy, 86.4% had a suppressed HIV viral load, and 44.9% smoked. The average age of patients was reported as 51.9 years. Comorbidities present in included patients (%) were: hypertension (55.8%), type 2 diabetes mellitus (15.7%), chronic kidney diseases (9.2%), coronary artery disease (5.4%), cerebrovascular disease (3.6%), and peripheral arterial disease (3.4%).
The study authors reported that of the patients who should be classified in Group 1 based on the ACA/AHA guidelines, 78 (64%) were not taking a statin and 43 (36%) were on statin therapy. For Group 2 patients, 5 (56%) were not taking a statin while 4 patients (36%) were. Fifty-five Group 3 patients (51%) were not on a statin while 52 (49%) were. Lastly, 151 patients in Group 4 (71%) were not on a statin while 62 (29%) were.
For each group, the percent of patients on low-, moderate-, and high-intensity statin doses, respectively, were reported as 30%, 56%, and 14% for Group 1, 29%, 63%, and 8% for Group 3, and 21%, 64%, and 15% for Group 4. For Group 2 patients, 75% were taking high-dose statins while 25% were taking moderate-dose statins.
The study authors stated, “Among patients who should be on statins based on guideline, the proportion of patients on antiretrovirals with potential drug-drug interaction with statins, specifically ritonavir, cobicistat and efavirenz, was similar between those who were prescribed statin and those who were not.” No significant differences were seen in the patients taking statins compared to those not taking statins in regards to CD4 count, chronic kidney disease, and pill burden.
Additionally, similar rates of ritonavir, cobicistat, and efavirenz use were observed between the two groups. It was noted that 95% of Group 4 patients that had viral suppression were prescribed a statin vs. 87% of Group 4 patients that did not have viral suppression (P=0.031).
“Our finding stresses the critical need to address this gap among HIV+ individuals,” Dr. Nom stated. He added, “It also emphasizes the need to prioritize ASCVD prevention in the care of the aging HIV-infected population.”
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Nom L, Ali N, Presti R, Powderly WG, Escota G. Statin Utilization among human-immunodeficiency virus (HIV)-infected individuals based on the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guideline. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org