Statin utilization and determinants of prescribing among people living with HIV in a Canadian tertiary care cohort

Background: People living with HIV (PLWH) have increased risk of atherosclerotic cardiovascular disease (ASCVD), even with sustained viral suppression. Persistent immune activation and chronic inflammation contribute to this risk and may be favourably modified by statins beyond lipid lowering. However, Canadian real-world statin utilization in PLWH remains poorly characterized. Methods: We conducted a cross-sectional cohort study of adults aged 40–75 years with HIV receiving care at a tertiary HIV centre in London, Ontario, Canada. Patients without a lipid panel within 3 years were excluded unless clinical ASCVD was documented. Sociodemographic, behavioural, clinical, laboratory, and HIV-related characteristics were compared by statin use. Multivariable logistic regression identified predictors of no-statin therapy, with missing data addressed using multiple imputation by chained equations. Results: Among 768 individuals with documented statin status, 589 (77%) were aged 40–75 years; 42% (248/589) were prescribed statins. Rosuvastatin and atorvastatin accounted for over 90% of prescriptions. Statin users were older (median 61 versus 51 years) and had more diabetes, hypertension, dyslipidemia, chronic kidney disease, and cardiovascular disease. In adjusted analyses, absence of statin therapy was associated with younger age (aOR = 0.93 per 1-year increase from mean age, 95% CI 0.90 to 0.96), male sex (aOR = 0.47, 95% CI 0.28 to 0.80), diabetes (aOR = 0.38, 95% CI 0.19 to 0.75), and dyslipidemia (aOR = 0.11, 95% CI 0.06 to 0.20). Conclusion: In this HIV cohort, statin prescribing was strongly aligned with traditional cardiometabolic risk factors and calculated ASCVD risk. Nonetheless, social vulnerability was associated with lower statin utilization, highlighting potential inequities in preventive cardiovascular care. These findings carry important implications for the post-REPRIEVE era, as statin eligibility expands among PLWH.