HIV and Statin Use in the Women's Interagency HIV Study

With the provision of effective antiretroviral therapy (ART) for HIV, increasingly the interactions between HIV, ART, and chronic diseases of aging, such as cardiovascular disease, are of interest. Dyslipidemia is a common condition found in HIV-infected patients. Reflecting changing national guidelines, treatment of dyslipidemia with statins has increased in the US, both in the general population and the HIV-infected population. It is unknown if HIV-infected patients are as likely to initiate statins when indicated, in comparison to HIV-uninfected patients. Regarding the efficacy of statins, previous work has shown a benefit to statin use for LDL cholesterol lowering, but with a slightly reduced benefit among HIV-infected patients. However, this question has not been examined extensively in women. We examined the effect of HIV serostatus on the use and efficacy of statins in the Women’s Interagency HIV Study (WIHS), a prospective multicenter cohort of HIV-infected women and matched HIV-uninfected controls in the US. Among 4607 women in the WIHS, 473 had an indication by Adult Treatment Panel (ATP) III guidelines and did not have prior statin use. Compared to HIV-uninfected women, the weighted hazard ratio for initiation of a statin for HIV-infected women was 0.95 (95% confidence interval (CI): 0.63, 1.44), and the two-year risk ratio was 0.82 (95% CI: 0.39, 1.24). We found little evidence of a difference by HIV serostatus, in the uptake of statins in our cohort. Among both HIV-infected and uninfected women, the prevalence of statin indication increased nearly three-fold when applying the 2013 American College of Cardiology/American Heart Association guidelines instead of the 2001 ATP III guidelines. We estimated the effect of HIV on the efficacy of statins, as measured by changes in LDL cholesterol from baseline (prior to statin initiation) to approximately one year of follow-up. Out of 659 statin initiators, 481 (73%) were HIV-infected. LDL cholesterol was reduced after approximately one year in both exposure groups. After adjustment the change in LDL cholesterol for HIV-infected women was -15.1 mg/dL, and in HIV-uninfected women it was -17.4 mg/dL. The difference in mean change was 2.3 mg/dL (95% CI: -5.4, 10.1).Doctor of Philosoph