title: Statin Utilization and Recommendations Among HIV- and HCV-infected Veterans: A Cohort Study.
abstract: Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infections are associated with increased risk of cardiovascular disease (CVD). The potential impact of recently updated cholesterol guidelines on treatment of HIV- and HCV-infected veterans is unknown.
  
  
  
  We performed a retrospective cohort study to assess statin use and recommendations among 13 579 HIV-infected, 169 767 HCV-infected, and 6628 HIV/HCV-coinfected male veterans aged 40-75 years. Prior 2004 Adult Treatment Panel (ATP-III) guidelines were compared with current 2013 American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines and 2014 US Department of Veterans Affairs (VA)/US Department of Defense (DoD) joint clinical practice guidelines using laboratory, medication, and comorbidity data from the VA Clinical Case Registry from 2008 through 2010.
  
  
  
  Using risk criteria delineated by the ATP-III guidelines, 50.6% of HIV-infected, 45.9% of HCV-infected, and 33.8% of HIV/HCV-coinfected veterans had an indication for statin therapy. However, among those eligible, 22.7%, 30.5%, and 31.5%, respectively, were not receiving ATP-III recommended statin therapy. When current cholesterol guidelines were applied by VA/DoD and ACC/AHA criteria, increases in recommendations for statins were found in all groups (57.3% and 66.1% of HIV-infected, 64.4% and 73.7% of HCV-infected, 49.1% and 58.5% of HIV/HCV-coinfected veterans recommended).
  
  
  
  Statins were underutilized among veterans infected with HIV, HCV, and HIV/HCV according to previous ATP-III guidelines. Current VA/DoD and ACC/AHA guidelines substantially expand statin recommendations and widen the gap of statin underutilization in all groups. These gaps in care present an opportunity to improve CVD prevention efforts in these at-risk populations.
authors.affiliation: Division of Infectious Diseases, Duke University Duke Clinical Research Institute.
authors.forename: Meredith E
authors.initials: ME
authors.lastname: Clement
authors.affiliation: Division of Infectious Diseases, Duke University Duke Global Health Institute.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Park
authors.affiliation: Duke Clinical Research Institute Division of Cardiology.
authors.forename: Ann Marie
authors.initials: AM
authors.lastname: Navar
authors.affiliation: Division of Infectious Diseases, Duke University.
authors.forename: Nwora Lance
authors.initials: NL
authors.lastname: Okeke
authors.affiliation: Duke Clinical Research Institute Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.affiliation: Duke Clinical Research Institute Division of Cardiology.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Division of Infectious Diseases, Duke University Duke Clinical Research Institute.
authors.forename: Susanna
authors.initials: S
authors.lastname: Naggie
mesh_terms: D000328:Adult; D000368:Aged; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000209:etiology; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012306:Risk; D012955:Societies, Medical; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol
keywords: cardiovascular disease; hepatitis C virus; human immunodeficiency virus; hydroxymethylglutaryl-CoA reductase inhibitors; statins