LAUSR

Background Knowledge about lipid interventions in secondary prevention in HIV‐infected individuals is limited; studies are sparse. Methods A prospective observational multicenter study enrolled 282 patients on statin 1 month after first acute coronary syndrome (ACS) (95 HIV‐infected individuals, 187 HIV‐uninfected). Data on fasting lipids (total cholesterol [TC], low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol [HDL‐C], non–HDL‐C, triglycerides, TC/HDL‐C ratio) were collected over 3 years. The evolution of lipid concentrations was analyzed using mixed‐effects models. Achievement of National Cholesterol Education Program Adult Treatment Panel III lipid goals and prescribed statin intensity was assessed. Results Mean age of patients was 49.0 years, and 94% were men. Baseline lipids were similar in the 2 groups. Six months after first ACS, less low‐density lipoprotein cholesterol reduction was observed in the HIV‐infected GROUP (adjusted mean change −10.13; 95% CI −20.63 to 0.37; P = .06) than in the HIV‐uninfected group (Adjusted mean change −38.51; 95% CI −46.00 to −31.04; P < .0001) Similar trends were observed for TC and non–HDL‐C. After ACS, initial statin prescription for HIV‐infected compared with HIV‐uninfected individuals was more frequently a moderate‐intensity statin (66% vs 45%) and less frequently a high‐intensity statin (15% vs 45%). Over 3 years of follow‐up, the proportion of HIV‐infected patients receiving high‐intensity statin remained persistently lower than the proportion observed in the HIV‐uninfected group. Conclusions In this observational study, HIV‐infected individuals after first ACS exhibited worse lipid profiles than controls particularly during the first 6 months while receiving less potent statins. Appropriate statin intensity should be prescribed in HIV‐infected individuals with awareness of potential drug‐drug interactions.