Statin use in HIV patients: how to navigate the potential risks

Statin use in HIV patients continues to spark important conversations, especially when balancing cardiovascular risk with potential side effects. In this case, practitioners weigh in on whether statin therapy should still be administered, given recent clinical trial results that show a potential risk of developing diabetes mellitus. 

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Results from a large randomized clinical trial involving over 7700 participants with HIV showed that pitavastatin may be associated with an increased risk of developing diabetes mellitus in patients with HIV. 

Questions for consult 

 Consults

Key takeaways about statin use in HIV patients to manage cardiovascular risk:

• Risk assessment is essential
  Practitioners recommend evaluating individual cardiovascular risk factors (e.g., hypertension, smoking, BMI, family history) and using shared decision-making.
  
• Statins are still favored
  Despite potential risks like diabetes, most practitioners support statin use in HIV-positive patients due to strong evidence of reduced cardiovascular events.
• Drug choice and monitoring matter
  Rosuvastatin and Pravastatin are preferred due to fewer interactions with HIV meds, with regular monitoring of glucose and A1C advised.
  

Family Practice

"This is a difficult question, as diabetes increases the risk of infection in an already immunocompromised group. I'd assess for other risk factors for heart disease to determine treatment, including history of HTN, smoking, BMI, family history, etc. I'd also calculate the patient's CV risk score and ultimately discuss risk/benefit with the patient and use mutual decision-making."

Cardiology

"Yes, I would. Despite these findings, statins have consistently shown reduced MACE in HIV patients. Therefore, given that many HIV patients have risk factors for CAD, I would continue to recommend statins."

Family Practice

"Yes, the benefits outweigh the risks. I would use Rosuvastatin and monitor periodically with Fasting sugars and A1C."

Family Practice

"HIV patients aren't at lower risk for CV disease than everyone else. I'd like to see any results (even if retrospective) for Rosuvastatin and Pravastatin. Cytochrome P450 is a big issue with HIV meds and some statins. And if they develop DM, aren't we going to put them on statins anyway? I likely would."

Cardiology

"Yes, I still would administer the meds because major clinical guidelines have determined that the cardiovascular benefits of statins in HIV-positive patients outweigh the risk of developing diabetes. The absolute benefit of preventing heart attacks and strokes is substantial, even with a modest increase in diabetes incidence."

To review all peer consults on whether statins should be used to manage cardiovascular risk in HVI patients, or share your own approach, read the full case on Healthcasts.