Statin Prescribing and Guideline Concordance Among Adults With HIV Aged 40–75 Years in a Single Urban Outpatient HIV Clinic, 2024

BACKGROUND: People with HIV (PWH) have elevated atherosclerotic cardiovascular disease (ASCVD) risk. Following the REPRIEVE trial, 2024 HHS Adult and Adolescent Antiretroviral Guidelines recommend at least moderate-intensity statins for adults with HIV aged 40-75 years with 10-year ASCVD risk 5% to <20%. The 2026 ACC/AHA Dyslipidemia Guideline expands eligibility, supporting statins for all adults aged 40-75 years with HIV for primary prevention, regardless of LDL-C. We evaluated statin prescribing and HHS guideline concordance for primary prevention in this population. SETTING: Single urban outpatient HIV clinic in the United States. METHODS: Retrospective electronic health record review of adults with HIV aged 40-75 years with an outpatient HIV visit on or after February 27, 2024. Statin prescribing was an active prescription at the index visit. ASCVD risk was abstracted from clinical documentation; virologic suppression was HIV RNA <50 copies/mL. Primary-prevention eligibility followed the February 27, 2024 HHS framework: LDL-C ≥70 mg/dL plus ASCVD risk ≥5% or diabetes mellitus. RESULTS: Of 753 patients reviewed, 414 met inclusion criteria. Statins were prescribed for 212 (51.2%). Statin-prescribed patients were older (median 62 vs. 54 years) with higher median ASCVD risk (13% vs. 7%). ASCVD risk was unavailable for 100 (24.2%). Among 242 patients eligible for primary-prevention statin therapy, 128 (52.9%) had an active statin prescription at the index visit. In multivariable modeling (n=314), higher ASCVD risk, higher CD4 count, and virologic suppression were independently associated with prescribing. CONCLUSIONS: Only half of statin-eligible adults with HIV were prescribed statins, with the largest gap among those eligible by ASCVD risk 5% to <20% without diabetes. The 2026 ACC/AHA guideline expands eligibility to all adults aged 40-75 years with HIV. These findings highlight opportunities to improve implementation of guideline-directed cardiovascular prevention through improved cardiovascular risk assessment, clinician education, and electronic clinical decision support.