Abstract 15234: Greater Statin Interruption Rates and Lower Adherence for Women versus Men With HIV in the United States

Abstract

Introduction: People with HIV, particularly women, have an elevated CVD risk, and a recent trial showed they can benefit from statin initiation even at low/moderate predicted CVD risk. Yet <50% of patients with HIV on statins experience adequate lipid reductions. To inform efforts to reduce CVD risk and gender disparities in this population, we examined statin persistence and adherence by gender in a nationwide sample of privately insured people with HIV. Methods: Among people with HIV ≥18 in MarketScan Commercial Claims who initiated a statin in 2015-2020, we used outpatient pharmacy claims to estimate 1) time to statin interruption (first gap >30 days) and 2) monthly proportion of days covered (PDC) by a statin. PDC analyses censored people if they were off statins ≥6 months. We estimated gender differences in interruption rates using hazard ratios (HR) and in having low adherence (PDC<80%) using risk ratios (RR) adjusted for age, calendar year, US census region, and employment status. Results: There were 7809 statin initiators (17% women; 60% in the South; median age 52 years, IQR 47-57). Two years after statin initiation, 81.0% (95% CI 78.1%-83.8%) of women and 69.8% (68.4%-71.3%) of men had ≥1 statin interruption (adjusted HR women vs. men 1.35 [1.25-1.46]) (Fig. 1A). Monthly PDC decreased in the first 6 months of statin use to 61% for women and 68% for men, then increased to 73% and 80%, respectively, after 2 years (Fig. 1B). Over all months, women more commonly had PDC<80%, with an adjusted RR of 1.27 (1.20-1.34). Conclusions: People with HIV had high statin interruption rates and adherence <80% at most time points, with disparities for women versus men. It is possible that, despite having insurance, women with HIV in this sample are more affected than men with HIV by socioeconomic and other barriers to statin adherence. Gender-specific efforts in people with HIV should address these barriers to promote adherence to CVD preventative pharmacotherapy in this population at high risk.