Background: Real-world clinical data on statin use and intensity among PLWH are sparse. We hypothesized that significant differences exist regarding statin utilization and dosing as well as on-statin total cholesterol (TC) lowering for PLWH compared with uninfected controls.
Methods: HIVE-4CVD is an electronic data repository of 5,041 PLWH and 10,082 uninfected controls frequency matched on age, sex, race, zip code, and clinic location receiving care at Northwestern Medicine from 1/1/2000 to 5/17/2017. Medication administration records, prescription data, and validated natural language extraction algorithms were used to extract statin utilization information. Statins were categorized by generic name and intensity (high, moderate, and low). Lipid values were analyzed and categorized as before or after statin initiation. We compared statin utilization for PLWH vs. controls and used multivariable-adjusted regression models to compare changes in TC levels after statin initiation for PLWH vs. controls.
Results: Among people on statins, PLWH were more likely than controls to have ever taken pravastatin (34.8% vs. 12.3%, p < 0.001) and atorvastatin (72.2% vs. 65.6%, p = 0.002), and less likely to have ever taken simvastatin (14.2% vs. 39.5%, p < 0.001). PLWH on statins were more likely to have their intensity reduced (14.6% vs. 11.2%, p = 0.034); this pattern was more apparent when analyses were restricted to patients on high-intensity statins (63.6% vs. 36.4%, p = 0.030). Although PLWH had borderline significantly less TC reduction after statin initiation than controls (-22.9 mg/dL vs. -28.5 mg/dL, p = 0.058; Figure 1), this association was attenuated after adjustment for age, sex, race, and pre-statin TC level (4.2 mg/dL greater TC lowering for controls than PLWH; p = 0.16).
Conclusions: Significant differences exist in type and intensity of statin utilized for PLWH compared with uninfected controls. Studies of patient and provider knowledge and preferences are needed to understand reasons underlying these differences.