Statins and HIV: Why Fewer Patients Are Receiving Treatment

October 28, 2025 Dr. Jennifer Chen Health

Summary of the Article: Cardiovascular Risk management in People with HIV

This article discusses the evolving guidelines and implementation of cardiovascular disease (CVD) prevention strategies in people living with HIV (PLHIV).Here’s a breakdown of the key points:

1. Increased Awareness of CVD Risk in PLHIV:

* PLHIV have a higher risk of CVD than the general population.
* The REPRIEVE study showed a 36% reduction in major cardiovascular events with statin use in PLHIV with low-to-intermediate risk.

2. Evolving Guidelines & Recommendations:

* Risk stratification: Guidelines now prioritize statin treatment for PLHIV with a cardiovascular risk of 5% or above.
* LDL Cholesterol targets: EACS and ESC guidelines recommend a 50% reduction in LDL cholesterol for higher-risk PLHIV (>5%), but achieving these targets can be challenging.
* Balancing Benefits & Risks: For PLHIV with low cardiovascular risk (<5%), the potential side effects of statins (like diabetes and muscle pain) may outweigh the benefits.
* Importance of Targets: Some experts argue that LDL targets are crucial for patient adherence and physician action.

3. impact of Guidelines – Italian Studies:

* Increased Statin Prescriptions: A study in Milan showed a significant increase in statin prescriptions after guideline updates (IR 4.50/100 PYFU to 11.75/100 PYFU, a 2.61-fold increase). the cumulative probability of receiving a statin also increased (17.6% vs 7.4%).
* impact Across Risk Levels: the increase in statin prescriptions was significant even in the low-to-intermediate risk group (16.9% vs 6.8%), but not in the high-risk group (29.3% vs 19.6%).
* Improved LDL Cholesterol Control: Another study in Milan showed an increase in both statin use (44% to 54%) and combination lipid-lowering therapy (9.6% to 18.2%) after the 2024 EACS guideline update.

In essence, the article highlights a growing recognition of CVD risk in PLHIV, leading to updated guidelines and, as demonstrated by Italian studies, increased implementation of preventative measures like statin therapy.