Maintenance of statin therapy among people living with HIV

• Published in: AIDS (London) Vol. 35; no. 4; pp. 567 - 574
• Main Authors: Boettiger, David C., Kerr, Stephen, Chattranukulchai, Pairoj, Siwamogsatham, Sarawut, Avihingsanon, Anchalee
• Format: Journal Article
• Language: English
• Published: England Lippincott Williams & Wilkins 15-03-2021; Copyright Wolters Kluwer Health, Inc
• Subjects: Aged; Anti-Retroviral Agents - therapeutic use; Cholesterol, LDL; HIV Infections - complications; HIV Infections - drug therapy; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Thailand; Thailand
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/QAD.0000000000002769

OBJECTIVE:Statins play a critical role in reducing the elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLHIV). However, maintaining statin therapy is difficult and may be impeded further in PLHIV due to the risk of antiretroviral therapy/statin interactions. We estimated rates of statin discontinuation and re-initiation, and the percentage of days covered by statin use among PLHIV on antiretroviral therapy, and investigated factors associated with these outcomes.
DESIGN:Observational cohort study.
METHODS:Clinical data from individuals attending the HIV-NAT Centre in Bangkok, Thailand between 2001–2020 were analyzed using Kaplan-Meier curves, competing-risk regression, and generalized estimating equations. Discontinuation was defined as statin cessation lasting 90 days.
RESULTS:Data on 318 PLHIV were included. After one, three and five years, 22.3%, 50.8% and 61.1% had discontinued statin use, respectively. Among those who discontinued (n = 178), 52.0% re-initiated statin use within five years. Factors associated with statin discontinuation were low education level, fewer concomitant medications, and lack of ASCVD. Factors associated with statin re-initiation were older age, diabetes, and high levels of low-density lipoprotein cholesterol. The adjusted mean percentage of days covered by a statin was 86.7%, 61.1% and 58.1% in the six months prior to one, three and five years of follow-up, respectively.
CONCLUSIONS:Maintenance of statin therapy is poor among PLHIV on antiretroviral therapy but is not associated with using contraindicated antiretroviral/statin combinations. A better understanding of statin use in PLHIV will aid clinicians treating individuals and policy makers designing interventions for population-level ASCVD risk reduction.