Women With HIV Fall Short of Statin-Use Guidelines

Jonathan Todd, PhD

A majority of women infected with human immunodeficiency virus (HIV) do not use statin drugs as recommended in recent guidelines, a new study suggests.

Statins reduce low-density lipoprotein (LDL) cholesterol to help control blood lipid levels and prevent cardiovascular disease (CVD). New guidelines released in 2013 increased the percentage of HIV-infected women for whom statins are recommended to 45% from 16%.

Preventing CVD is especially important in HIV-positive women, Jonathan Todd, PhD, from the University of North Carolina, in Chapel Hill, and a national team of coauthors wrote. “Non-HIV associated conditions have emerged as the leading causes of mortality among persons living with HIV. Among these, CVD has become a major health threat,” they wrote.

The researchers evaluated the use of statins by both HIV-infected and HIV-uninfected women for whom the drugs were indicated. Both groups displayed lower use than recommended under today’s guidelines from the American College of Cardiology and the American Heart Association (ACC/AHA). These guidelines expanded the indication for statin initiation from previous recommendations suggested in the Adult Treatment Panel III (ATP III) report of the National Cholesterol Education Program (NCEP).

The researchers found that cumulative incidence of statin use 5 years after it was indicated was 38% in HIV-seropositive women, lower than the 45% for which statin use was suggested. That is troubling because those living with HIV may have heightened immune activation, inflammation, and higher rates of CVD, previous studies have found.

“Clinicians treating HIV-seropositive women should consider more aggressive management of the dyslipidemia often found in this population,” the researchers said. In HIV-seronegative women, statin usage was 30%.

To report on statin use, the authors reviewed data from the Women's Interagency HIV Study (WIHS) for the years 2000 to 2014. The multicenter, prospective, cohort study included women with HIV infection and controls who did not have the virus.

Participants completed semiannual study visits, including an extensive interview on medication history, behavioral risk factors and HIV-related outcomes.

A total of 3453 women qualified for the study. At least 1 indication for statin use was found in 581 of the women under the earlier ATP III guidelines.

Applying the ACC/AHA guidelines more than doubled the number of women with an indication for a statin. Compared to the 581 under the ATP III guidelines (including those with less than a year of follow-up for actually initiating a statin), 1508 women were indicated for statins under the newer ACC/AHA guidelines.

“These findings indicate a possible target for intervention in this vulnerable population,” the researchers wrote. “They also highlight the need for the development and implementation of strategies to optimize preventive healthcare for women, both with and without HIV.”

While potential risks of CVD drive much of statin use, HIV infection adds another dimension, the authors said. “There is also increasing interest in the use of these agents for their potential anti-inflammatory properties,” they noted.

Whether women with HIV are particularly subject to a lack of care when it comes to statins is unclear, the authors said.

“To what extent women with HIV experience barriers to preventive care for CVD is not well understood,” the authors said.

However, the researchers cautioned that despite advances in simplifying antiretroviral treatment (ART) regimens, people with HIV are often prescribed a complex mix of medications that include multiple drugs for HIV and comorbid conditions.

“Polypharmacy in this population may be a concern for treating physicians, and may result in under-treatment of existing comorbid conditions such as dyslipidemia,” the authors said.

The study, "Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women," was published in AIDS Patient Care and STDs.