Statins and Aspirin in HIV-infected People: Gap between Guidelines and Clinical Practice. The Results of the HIV-HY Study

Objectives: International guidelines mandate interventions to prevent cardiovascular diseases (CVD) in HIV-infected patients as in general population, but few data are available from clinical practice in HIV-positive people. Methods: Multicenter, nationwide, prospective cohort study, sampling 991consecutive HIV-infected patients. In a 4-year followup, we investigated CVD prevention care practices involving the use of acetylsalicylic-acid (ASA) and statins. Statin prescription was evaluated according to two guidelines: The Third-Report of The National-Cholesterol-Education-Program (ATPIII) and The American College of Cardiology/American Heart Association (ACC/AHA) Recommendations. Results: Patients were mostly males (70.8%) with mean age at enrolment of 46.4 years (interquartile-range 23-77, standarddeviation 9.5). The median time of follow-up was 40 months (interquartile-range 35-47), patient-years 3235. At the end of follow-up, 151 (15.2%) patients were on statin treatment. Particularly, statins were taken by 151 out of 351 (43.0%) patients who should be on statin therapy according to the ATPIII guidelines, and by 151 out of 395 (38.9%) subjects according to the ACC/AHA recommendations. Overall, 62.2% of patients on statins achieved the ATPIII recommended LDL-C level. At univariate analysis traditional risk factors such as age, hypertension, smoking, previous CVD event, high CVD-risk and lower eGFR were strongly associated with statin prescription, while there was an inverse association with chronic hepatitis. At the last follow-up visit, 97 out of 991 patients (9.8%) were treated with ASA, and the ratio between subjects on ASA and those who needed ASA for secondary CVD prevention was 50/74 (67.6%). The main factors associated with ASA prescription was statin use and high CVD-risk. Conclusion: The prescription of statins and aspirin in HIV-people remains widely sub-optimal, especially for statins, since only about 40% and 68% of patients requiring statin and ASA use, respectively, are properly treated. Therefore, improving preventative CVD care in HIV-positive people is an important step towards diminishing the CVD-risk in this population.