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AIDS Patient Care STDS. 2017 Nov;31(11):447-454. doi: 10.1089/apc.2017.0145.

Underutilization of Statins When Indicated in HIV-Seropositive and Seronegative Women.

Author information

1
1 Institute for Global Health and Infectious Diseases, University of North Carolina , Chapel Hill, North Carolina.
2
2 Department of Epidemiology, University of North Carolina , Gillings School of Global Public Health, Chapel Hill, North Carolina.
3
3 Division of Cardiology, Department of Medicine, University of North Carolina , Chapel Hill, North Carolina.
4
4 Department of Clinical Pharmacy, University of California San Francisco School of Pharmacy , San Francisco, California.
5
5 Department of Family Medicine, Georgetown University Medical Center , Washington, District of Columbia.
6
6 Department of Medicine, Albert Einstein College of Medicine , Bronx, New York.
7
7 Department of Cardiovascular Disease, SUNY Downstate Medical Center , Brooklyn, New York.
8
8 Department of Preventive Medicine, Keck School of Medicine, University of Southern California , Los Angeles, California.
9
9 Department of Medicine, Cook County Health and Hospital System and Rush University , Chicago, Illinois.
10
10 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland.
11
11 Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta, Georgia .
12
12 Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham , Birmingham, Alabama.

Abstract

Increased life expectancy of persons living with HIV infection receiving antiretroviral therapy heightens the importance of preventing and treating chronic comorbidities such as cardiovascular disease. While guidelines have increasingly advocated more aggressive use of statins for low-density lipoprotein (LDL) cholesterol reduction, it is unclear whether people with HIV, especially women, are receiving statins when indicated, and whether their HIV disease is a factor in access. We assessed the cumulative incidence of statin use after an indication in the Women's Interagency HIV Study (WIHS), from 2000 to 2014. Additionally, we used weighted proportional hazards regression to estimate the effect of HIV serostatus on the time to initiation of a statin after an indication. Cumulative incidence of statin use 5 years after an indication was low: 38% in HIV-seropositive women and 30% in HIV-seronegative women. Compared to HIV-seronegative women, the weighted hazard ratio for initiation of a statin for HIV-seropositive women over 5 years was 0.94 [95% confidence interval (CI) 0.62, 1.43]. Applying the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines increased the proportion of HIV-seropositive women with a statin indication from 16% to 45%. Clinicians treating HIV-seropositive women should consider more aggressive management of the dyslipidemia often found in this population.

KEYWORDS:

cardiovascular disease; human immunodeficiency virus; hydroxymethylglutaryl-CoA reductase inhibitors; lipids; statins; women's health

PMID:
29087746
PMCID:
PMC5665094
DOI:
10.1089/apc.2017.0145
[Indexed for MEDLINE]
Free PMC Article

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