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

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.”