REPRIEVE in practice: a single-centre longitudinal service evaluation of implementing best-practice cardiovascular disease prevention in people living with HIV

Objectives To determine the number of eligible people living with HIV (PLWHIV) in a London tertiary care centre receiving statins and cardiovascular health lifestyle advice; to determine whether age, sex or QRISK3 cardiovascular risk score influences statin prescription; to identify barriers to statin access in the HIV clinic to General Practice pathway; and to determine whether statin prescriptions were continued after 6 months. Methods A retrospective review of clinic letters from consecutive patients attending specialist HIV clinic appointments in April 2024, and their 6-month follow-up appointments, was conducted via electronic patient records. Results Seven hundred and sixteen consultations were extracted, representing 358 participants, at two different time points: 195 (54%) patients were eligible for statin initiation at their initial appointment and 94 (48% of the eligible patients) had a recorded discussion around statin initiation in HIV clinic. Fifty (53% of patients who had a discussion) gave consent to begin statins. Only 28 (56% of consenting patients) were prescribed a statin. Smoking status was not up to date for 64 (33%) of PLWHIV eligible for statins and 141 (72%) did not have cardiovascular health lifestyle modification discussion. Multivariable regression found only QRISK3 score significantly affected statin discussion (OR: 1.137, 1.030 to 1.271) and initiation (OR: 1.244, 1.100 to 1.430). Conclusions Many PLWHIV eligible for statins are not discussing this with their clinician; some willing patients are still not prescribed a statin. PLWHIV may be missing out on lifestyle advice for preventing cardiovascular disease. Further support for PLWHIV in both primary and secondary care would be useful to increase statin uptake.