Contraindicated statin use declined between 2007 and 2015 in HIV-infected adults treated with antiretroviral therapy (ART), while overall use remains suboptimal, researchers report.
HIV is associated with an increased risk for atherosclerotic cardiovascular disease, especially with the aging of the HIV-infected population, and many patients are taking statins. Some statins, though, are contraindicated because of their adverse interactions with certain antiretroviral therapies and other medications commonly used by HIV-infected patients.
Dr. Robert S. Rosenson from Icahn School of Medicine at Mount Sinai, in New York City, and colleagues used data from the Marketscan database to analyze trends in the use of statins and contraindicated statin use among more than 186,000 adults living with HIV who were treated with ART between 2007 and 2015.
During this time, statin use overall remained consistent, within two percentage points, the researchers report the Journal of the American Heart Association, online December 7.
Contraindicated statin use – defined by a pharmacy fill for a statin type and dosage that should not be used because of an increased risk for statin-related adverse events based on the medications filled in the preceding 90 days – fell significantly from 16.3% in 2007 to 9.0% in 2014 before rebounding to 9.8% in 2015.
The decline resulted primarily from the decreased use of HIV protease inhibitors, whereas the increased use of contraindicated statins between 2014 and 2015 was primarily attributable to cobicistat, which inhibits human CYP3A; this enzyme not only metabolizes some antiretroviral medications but also interacts with some statins.
Factors independently associated with an increased risk for taking a contraindicated statin included older age, male sex, living in U.S. regions other than the Northeast and having a history of coronary heart disease, hypertension, or diabetes.
“The current analysis expands on prior studies by showing that the use of statin therapy has not increased between 2007 and 2015 among beneficiaries with HIV,” the researchers note. “This finding is concerning as factors associated with a higher CVD risk, including older age, history of CHD, diabetes mellitus, and chronic kidney disease have increased among beneficiaries with HIV over this time period.”
“The current study supports the need to increase the appropriate use of statins among people living with HIV consistent with clinical practice guidelines,” they conclude. “Also, clinicians should be vigilant in prescribing statin types and dosages with no or minimal contraindications among adults living with HIV.”
Dr. Rosenson did not respond to a request for comments.
J Am Heart Assoc 2018.