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.