Statin use and LDL cholesterol target attainment in people with HIV after European AIDS Clinical Society 2024 guideline updates.

Abstract

The 2024 EACS guidelines introduced stricter LDL-C targets, emphasizing lipid management in people with HIV (PWH). We aimed to assess changes in statin prescription following the guideline update. This retrospective, single-center study compared PWH aged ≥40 years attending follow-up visits between April 2023-April 2024 (Period 1) and April 2024-April 2025 (Period 2). Lipid-lowering therapy use and LDL-C target attainment were evaluated according to 2024 EACS criteria. A total of 1379 individuals were included in Period 1 and 1191 in Period 2. Median LDL-C decreased from 116 mg/dL (IQR 92-139) to 111 mg/dL (IQR 84-137). Statin use increased from 38% to 49% (aOR 1.47, 95% CI 1.37-1.58; p < 0.0001), with greater use of statin-ezetimibe combination therapy (9% vs 19%, p < 0.0001). LDL-C target attainment remained low (8% vs 10%). In multivariable analysis, individuals of African (aOR 0.39, 95% CI 0.21-0.72; p = 0.003) and Hispanic (aOR 0.35, 95% CI 0.19-0.62; p < 0.001) origin had lower odds of receiving statins compared with Caucasians. Statin prescription increased after the 2024 guideline update, but LDL-C target attainment remained poor, suggesting incomplete implementation of guideline-recommended lipid management in routine HIV care.