Long-term non-statin lipid-lowering therapy (LLT) was associated with reduced risk for mortality among people living with HIV (PLWH), according to findings published in BMC Infectious Diseases.
All veterans (N=23,276) who were HIV-positive and cared for by the Veterans Affairs centers in the United States between 1996 and 2011 were included in this study. Clinical outcomes and medication exposures were assessed for a median of 5.2 (interquartile range [IQR], 2.5-9.2) years.
Participants were aged a median of 53 years (IQR, 46-60). In total, 2.5% were women, 46% were Black, 27% had prevalent atherosclerotic cardiovascular disease (ASCVD), 26% had hepatitis C coinfection, 11% had congestive heart failure, 10% had peripheral vascular disease, and 10% had chronic kidney disease.
A total of 20% of the patients died during the study, which was greater than 3 times the rate observed among an age, ethnicity, and gender matched sample from the general population. Most deaths (72%) occurred among patients with prevalent ASCVD and without virologic suppression (51%).
Serious infections (28%), new cancer diagnoses (15%), and acute ASCVD events (6%) were observed. Most patients were exposed to antihypertensives (63%) and over a third took LLT (36%) or aspirin (35%).
Decreased all-cause mortality was associated with patients who were exposed to LLT with (hazard ratio [HR], 0.59; 95% CI, 0.51-0.69; P <.0001) or without (HR, 0.71; 95% CI, 0.54-0.93; P =.03) statins during the last year. Similarly, patients exposed to LLT without statins (HR, 0.27; 95% CI, 0.15-0.48; P <.0001), LLT with statins (HR, 0.34; 95% CI, 0.23-0.52; P <.0001) or statin monotherapy (HR, 0.48; 95% CI, 0.35-0.66; P <.0001) for >91% of the last year were associated with decreased all-cause mortality.
Exposure to LLT without statins for most of the last year was also associated with decreased risk for any acute ASCVD events (HR, 0.24; 95% CI, 0.11-0.53; P =.002) and coronary events (HR, 0.17; 95% CI, 0.06-0.49; P =.004). For patients receiving LLT with statins, there was a decreased risk for cerebrovascular events (HR, 0.25; 95% CI, 0.09-0.68; P =.02) and infections (HR, 0.66; 95% CI, 0.47-0.92; P =.04).
This study may have been limited by not having access to data on the specific causes of death.
These data indicated that long-term, consistent exposure to LLT was associated with greatly reduced mortality rates. Prospective studies of LLT among PLWH are needed to determine how effective a prophylaxis of LLT may be for preventing ASCVD events among this population.
Drechsler H, Ayers C, Cutrell J, Arasaratnam R, Bedimo R. Consistent use of lipid lowering therapy in HIV infection is associated with low mortality. BMC Infect Dis. 2021;21(1):150. doi:10.1186/s12879-021-05787-4