Differences in Statin Utilization and Lipid-Lowering by Race, Ethnicity, and HIV Status in a Real-World Cohort of Persons with Human Immunodeficiency Virus and Uninfected Persons

Abstract Background Risks for cardiovascular diseases, including myocardial infarction and stroke, are elevated in people with HIV infection (PWH). However, no trials of statin utilization with clinical cardiovascular disease (CVD) endpoints have been completed in PWH, and there are sparse real-world data regarding statin use and lipid-lowering effectiveness. We therefore used a unique cohort of PWH and uninfected controls to evaluate (1) differences in statin types used for PWH vs. uninfected persons; (2) lipid lowering achieved by statin use for PWH vs. uninfected persons; and (3) racial and ethnic disparities in appropriate statin use among PWH and uninfected persons. Methods We analyzed a cohort of 5,039 PWH and 10,011 uninfected demographically matched controls who received care at a large urban medical center between January 1, 2000 and May 17, 2017. Medication administration records, prescription data and validated natural language processing algorithms were used to determine statin utilization. Statins were categorized by generic active ingredient name and intensity (high, moderate, or low). Lipid values collected in routine clinical care were available for analysis. The first set of analyses was restricted to PWH and uninfected matched controls taking statins and compared (1) differences in statin type and (2) difference in cholesterol levels after vs. before statin initiation by HIV status. For the second set of analyses, we first used prevalent CVD risk factors to determine participants with statin indications, then determined how many of these participants were taking statins. We then compared statin utilization among persons with indications for statins by race/ethnic group for PWH and uninfected matched controls using multivariable-adjusted logistic regression. Results Among people prescribed statins, PWH were more likely than controls to have ever taken pravastatin (34.8% vs. 12.3%, p Conclusions Among PWH with statin indication(s), Blacks and Hispanics were less likely than whites to have been prescribed a statin. These racial/ethnic disparities were less pronounced among uninfected persons. There were significant differences in type of statin utilized for PWH compared to uninfected matched controls. Future efforts addressing disparities in CVD prevention among PWH are warranted.