Gender Differences in Statin Discontinuation and Adherence Among Privately Insured People with HIV in the USA

Background People with HIV (PWH), particularly women, have a high cardiovascular disease (CVD) burden compared to the general population. There is little evidence describing statin adherence among PWH, which could inform interventions to reduce CVD disparities. Objective Observational cohort of privately insured PWH under age 65 who initiated statin therapy during 2015–2022 in MarketScan data. Main Measures We used outpatient pharmacy claims to examine (1) statin discontinuation, defined as a gap > 90 days, and (2) proportion of days covered (PDC) by a statin in 90-day intervals. We estimated hazard ratios (HRs) using Cox models to compare discontinuation rates and prevalence ratios (PRs) from log-binomial regression to compare the probability of having low adherence (PDC < 80%) between women and men. We adjusted for potential confounding by demographic and clinical factors and accounted for repeated PDC measures. Key Results We included 9522 PWH who initiated a statin (median age 52 years, 17.3% women). Overall, 50.0% of PWH had statin discontinuation within 2 years, and 26.5% had low adherence during statin therapy. Within 2 years, 59.0% of women and 48.1% of men had experienced discontinuation (adjusted HR 1.30 (95% CI, 1.20–1.41)). Among PWH remaining on statins, low adherence (PDC < 80%) was more common among women (34.1%) than men (25.2%) (adjusted PR 1.29 (1.22–1.35)). Conclusions PWH had high statin discontinuation rates, and a quarter had low adherence. Compared to men, women were both more likely to discontinue and have lower adherence. Efforts are needed to address statin adherence barriers to prevent CVD in PWH, especially in women with HIV.