Statins Utilization in Adults With HIV: The Treatment Gap and Predictors of Statin Initiation

Sally B. Coburn, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Raynell Lang, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Jinbing Zhang, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Frank Joseph Palella, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL.
Michael A. Horberg, Mid-Atlantic Permanente Research Institute, Rockville, MD.
Jose Castillo-Mancilla, Division of Infectious Disease, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Kelly Gebo, School of Medicine, Johns Hopkins University, Baltimore, MD.
Karla I. Galaviz, Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, IN.
M John Gill, Department of Medicine, University of Calgary, Calgary, Canada.
Michael J. Silverberg, Kaiser Permanente Northern California, Oakland, CA.
Todd Hulgan, Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN.
Richard A. Elion, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC; and.
Amy C. Justice, Yale University Schools of Medicine and Public Health and the Veterans Affairs Connecticut Healthcare System, New Haven, CT.
Richard D. Moore, School of Medicine, Johns Hopkins University, Baltimore, MD.
Keri N. Althoff, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.

Document Type

Journal Article

Publication Date

12-15-2022

Journal

Journal of acquired immune deficiency syndromes (1999)

Volume

91

Issue

5

DOI

10.1097/QAI.0000000000003083

Abstract

BACKGROUND: We characterized trends in statin eligibility and subsequent statin initiation among people with HIV (PWH) from 2001 to 2017 and identified predictors of statin initiation between 2014 and 2017. SETTING: PWH participating in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) enrolled in 12 US cohorts collecting data on statin eligibility criteria/prescriptions from 2001 to 2017. METHODS: We determined the annual proportion eligible for statins, initiating statins, and median waiting time (from statin eligibility to initiation). Eligibility was defined using ATP III guidelines (2001-2013) and ACC/AHA guidelines (2014-2017). We assessed initiation predictors in 2014-2017 among statin-eligible PWH using Poisson regression, estimating adjusted prevalence ratios (aPRs) with 95% confidence intervals (95% CIs). RESULTS: Among 16,409 PWH, 7386 (45%) met statin eligibility criteria per guidelines (2001-2017). From 2001 to 2013, statin eligibility ranged from 22% to 25%. Initiation increased from 13% to 45%. In 2014, 51% were statin-eligible, among whom 25% initiated statins, which increased to 32% by 2017. Median waiting time to initiation among those we observed declined over time. Per 10-year increase in age, initiation increased 46% (aPR 1.46, 95% CI: 1.29 to 1.67). Per 1-year increase in calendar year from 2014 to 2017, there was a 41% increase in the likelihood of statin initiation (aPR 1.41, 95% CI: 1.25 to 1.58). CONCLUSIONS: There is a substantial statin treatment gap, amplified by the 2013 ACC/AHA guidelines. Measures are warranted to clarify reasons we observe this gap, and if necessary, increase statin use consistent with guidelines including efforts to help providers identify appropriate candidates.

Department

Medicine

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