Association between statin use, atherosclerosis, and mortality in HIV-infected adults

PLoS One. 2020 Apr 30;15(4):e0232636. doi: 10.1371/journal.pone.0232636. eCollection 2020.


Background: While HIV infection is associated with increased cardiovascular risk, benefit from statin is not well established in HIV-infected adults. We assessed whether statins are associated with a decrease in carotid artery intima-media thickness (cIMT) progression and all-cause mortality in HIV-infected adults who are at elevated ASCVD risk and recommended for statins.

Methods: Carotid IMT was measured at baseline and follow-up in 127 HIV-infected adults who meet ACC/AHA criteria to be on statins. Inverse probability of treatment weighting (IPTW) was used to address selection bias. Multivariable models were used to control for baseline characteristics.

Results: 28 subjects (22%) were on statins and 99 subjects (78%) were not. Mean cIMT at baseline was 1.2 mm (SD = 0.34) in statin users and 1.1 mm (SD = 0.34) in non-users, and the multivariable adjusted difference was 0.05mm (95%CI -0.11, 0.21 p = 0.53). After 3.2 years of follow-up, average cIMT progression was similar in statin users and non-users (0.062mm/yr vs. 0.058 mm/yr) and the multivariable adjusted difference over the study period was 0.004 mm/yr (95% CI -0.018, 0.025, p = 0.74). All-cause mortality appeared higher in non-statin users compared with statin users, but the difference was not significant (adjusted HR = 0.74, 95%CI 0.17-3.29, p = 0.70).

Conclusion: In a HIV cohort who had elevated ASCVD risk and meet ACC/AHA criteria for statins, treatment with statins was not associated with a reduction in carotid atherosclerosis progression or total mortality. Future studies are needed to further explore the impact of statins on cardiovascular risk in the HIV-infected population.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Carotid Artery Diseases / diagnosis
  • Carotid Artery Diseases / epidemiology*
  • Carotid Artery Diseases / prevention & control
  • Carotid Intima-Media Thickness
  • Cause of Death*
  • Cohort Studies
  • Disease Progression
  • Female
  • Follow-Up Studies
  • HIV Infections / complications*
  • HIV Infections / mortality
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Male
  • Middle Aged
  • Risk Assessment
  • Risk Factors


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors