(CSPOT02) Gender Differences in Statin Persistence across Racial and Ethnic Groups among Persons with HIV in the United States

Background: Cardiovascular disease (CVD) risk is elevated for persons with HIV (PWH), particularly among women. In the United States, >50% of women with HIV are Black. Evidence on statin use following initiation in PWH is lacking and could inform interventions to reduce demographic disparities in CVD among PWH.

Objectives: Estimate gender differences in statin persistence among PWH initiating statin therapy for CVD prevention, overall and by race/ethnicity.

Methods: Within a clinical cohort at 8 US sites, we included PWH who received their first statin prescription recorded in the electronic health record (EHR) between 2014 and 2021 with no documented CVD history. We used Kaplan Meier estimates and hazard ratios (HRs) to compare time from statin initiation to the first interruption, defined as a gap >90 days in prescription coverage for any statin, between cisgender men and women. Analyses were adjusted for age and calendar year at initiation and stratified by race/ethnicity.

Results: Among 2957 PWH, 81% were men, 46% Black, 11% Hispanic, and 39% white. At statin initiation, the median age was 55 years (IQR 48, 60), the median CD4 count was 613 cells/µL (IQR 401, 860), 92% of PWH had an HIV RNA < 200 copies/mL, and 6% had an LDL cholesterol >190 mg/dL. Women were more likely than men to be Black (75% vs. 40%) and have diabetes mellitus (35% vs. 22%). The most commonly prescribed first agent was atorvastatin (69%), followed by rosuvastatin (16%) and pravastatin (12%). Among those with dosage information (n=2432), 9%, 71%, and 20% initiated a low, medium, and high intensity statin, respectively. Overall, women were more likely to have a statin interruption with 34.2% (95% CI 30.3%, 38.5%) after 2 years, compared with 30.0% (28.2%, 32.0%) among men. The age- and year-adjusted HR comparing women to men was 1.17 (95% CI 1.02, 1.35). Further stratified by race/ethnicity, 2-year statin interruption estimates were 27.5% (24.7%, 30.6%) for Black men (n=957), 31.0% (25.8%, 36.9%) for Hispanic men (n=286), 31.9% (29.1%, 34.9%) for white men (n=1053), 31.8% (27.4%, 36.7%) for Black women (n=415), 37.9% (23.0%, 57.9%) for Hispanic women (n=29), and 44.1% (34.4%, 55.2%) for white women (n=91). The age- and year-adjusted HRs comparing women to men were 1.12 (0.93, 1.34), 1.34 (0.76, 2.39), and 1.57 (1.17, 2.12) among Black, Hispanic, and white PWH, respectively.

Conclusions: Approximately one-third of PWH in this cohort experienced a statin interruption within 2 years of initiation. Statin interruption rates were higher for cisgender women compared to men, and this gender disparity was more pronounced among white PWH. Efforts are needed to understand the drivers of these disparities and improve CVD prevention through consistent statin use among all PWH.