Statin Use Low in Patients With HIV

Despite high coronary heart disease risk, most patients with HIV are not taking statins.
Despite high coronary heart disease risk, most patients with HIV are not taking statins.

Antiretroviral therapy (ART) has prolonged the lives of many HIV-infected patients such that coronary heart disease (CHD) has now become a leading cause of death in this patient population. Among HIV patients, statins are considered a first-line therapy for preventing CHD, but how many patients are actually taking them, and are they taking statins that may be contraindicated to their ART regimen?

To investigate what proportion of HIV patients are taking statins and whether they are taking contraindicated medications, researchers from the Icahn School of Medicine at Mount Sinai and Amgen conducted a retrospective cohort study of adult HIV patients aged ≥20 years with commercial health insurance in 2014. Findings were presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology in Washington, DC.

Statin use was defined as having a prescription filled within the calendar year. Contraindicated use was defined as a statin type or dose with a major drug interaction filled in the past 3 months, including protease inhibitors, cobicistat, antibiotics, azole antifungal medication, calcium antagonists, and gemfibrozil. Lead author Robert S. Rosenson added, "Factors associated with taking a contraindicated statin were also determined."

Among 23,119 HIV patients, 26% were taking statins, with 9% of these patients taking a contraindicated statin. Of patients taking a contraindicated statin, 62.4% had a prescription filled for a protease inhibitor in the 3 months prior to their first contraindicated statin fill. Generally, older patients, males, patients with CHD, hypertension, diabetes,  and those taking protease inhibitors were more likely to be on a statin. Patients taking NRTIs and non-NRTIs were less likely to be taking a contraindicated statin, while those with diabetes were more likely to be on one.

"Despite high CHD risk, most HIV+ patients are not taking statins. Among those [HIV+ patients] taking statins, some take contraindicated types and doses which may increase their risk for major drug interactions," concluded Rosenson.

Reference

Rosenson RS, Taylor B, Chen L, et al. Use of recommended and contraindicated statins in HIV patients. Abstract 1148-069. Presented at: the 66th Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.

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