HIV-positive women less likely to use statins, even though they qualify

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Women who test positive for HIV are at increased risk for cardiovascular disease but are less likely to be prescribed statins to control that risk, according to a study published in AIDS Patient Care and STDs this week.

HIV-positive patients have statistically struggled with gaining access to statins, first author Jonathan V. Todd, PhD, and colleagues wrote in the study, despite the ever-growing necessity of the preventative drug. Due to the development of effective antiretroviral therapies, treatment of HIV-seropositive women has shifted more toward preventing chronic illnesses that could aggravate pre-existing conditions—illnesses like cardiovascular disease (CVD).

Non-HIV illnesses are now the leading causes of mortality in HIV-positive individuals, Todd et al. wrote, with CVD emerging in recent years as a “major health threat.” Risk reduction can be achieved through both lifestyle changes and the reduction of atherogenic lipids—specifically low-density lipoprotein (LDL) cholesterol—which can be controlled with statins.

Yet, the authors said, it’s unclear whether these medications are prescribed equally to female patients, and particularly those who are HIV-positive.

“Current guidelines do not differentiate indications for statin use by HIV status, yet HIV is recognized as a risk factor for CVD,” Todd and co-authors wrote. “To what extent women with HIV experience barriers to preventive care for CVD is not well-understood.”

The authors called HIV-seropositive women “a chronically understudied population in HIV research” and prone to discrimination in terms of quality care. Past reports have determined HIV-positive patients as a whole are less likely to receive aspirin, lipid-lowering therapy and acute procedures after a heart attack.

The researchers narrowed a pool of nearly 5,000 women enrolled in the Women’s Interagency HIV Study to a final analysis cohort of 471 women who indicated qualification for statin use. Of that group, 321 women were HIV-seropositive; the remaining individuals were seronegative. HIV-positive patients were more likely to be white and older, according to the data, and the cohort’s median LDL cholesterol was 165 mg/dL.

Todd et al. found that while there was no significant difference in the uptake of statins between HIV-positive and HIV-negative patients with an indicated use for the drugs, cumulative incidence of statin use was just 38 percent and 30 percent in HIV-positive and HIV-negative women, respectively, after five years of study. Applying American College of Cardiology and American Heart Association (ACC/AHA) guidelines, which were the subject of debate after they expanded statin indication boundaries in 2013, did increase the percentage of HIV-seropositive women with a statin indication from 16 percent to 45 percent.

The authors said in the study their results express a possible need for intervention in this vulnerable population.

“Clinicians treating women with HIV should consider more aggressive management of the dyslipidemia often found in this population,” they suggested. “For HIV-seropositive women, who may be at heightened risk for CVD, the stakes may be higher, and approaches to applying the newer ACC/AHA guidelines that expand the indication for statin therapy, should be integrated into their primary and HIV care.”