Statin Use Rises but Gaps Persist in HIV Care: HIV Glasgow 2026

Statin use for primary cardiovascular prevention increased among people living with HIV in the Netherlands between 2023 and 2025, but fewer than half of those at very high cardiovascular risk were receiving a statin or another lipid-lowering drug in 2025. The nationwide findings, presented at HIV Glasgow 2026, show how prescribing changed in the years following updated recommendations.

Prescribing After REPRIEVE

The 2023 publication of REPRIEVE led to updated European AIDS Clinical Society recommendations on statin use in people living with HIV. Researchers used the Dutch ATHENA observational cohort to examine how prescribing for primary prevention changed around this period and which groups were less likely to receive treatment.

The analysis included 15,243 people aged 40–75 years in HIV care. It focused on people without established cardiovascular disease or type 2 diabetes. Researchers used SCORE2 for people aged 40–69 and SCORE2-OP for older participants, grouping them according to their estimated 10-year cardiovascular risk. The study’s measure of statin use also included prescriptions for other lipid-lowering drugs. Men made up 82% of the cohort, a feature of the study population that is relevant when interpreting the results by sex.

Between 2023 and 2025, treatment use rose from 29% to 46% in the very-high-risk group, a gain of 17 percentage points. In the high-risk group, use rose from 22% to 32%. Among those at low or moderate risk, it rose from 13% to 19%. The largest increase occurred in the group with the highest estimated risk, although 54% of that group still had no current lipid-lowering prescription in 2025.

Who Was Less Likely to Receive Treatment?

Among participants at very high risk in 2025, 8% had previously stopped a statin and 3% had declined one. The analysis included these patients in its measure of non-use, so the overall figure covers people with different prescribing histories. This distinction matters when assessing whether the gap reflects treatment initiation, continuation or individual preferences.

Across the cohort, women and younger participants were more likely to be without a lipid-lowering prescription in the 2025 analysis. Adjusted non-use was also less common in 2025 than in 2023, with an adjusted prevalence rate ratio of 0.89 (p<0.0001).

The study measured prescribing and relied on estimated cardiovascular risk. It could describe trends after REPRIEVE and the guideline updates, but its observational design could not establish what caused the increase or how many cardiovascular events prescribing changes prevented. For HIV services, the clearest finding was the remaining gap among people classified as very high risk, even after the strongest rise in prescribing.

Reference

Smit C, Wit F, De Vries-Sluijs D, et al. Statin use for primary prevention of cardiovascular disease among individuals with HIV in the Netherlands, impact of updated (inter)national guidelines. Abstract O37.2. Presented at: HIV Glasgow 2026; 8–11 November 2026; Glasgow, UK. J Int AIDS Soc. 2026;29(Suppl 6):e70211. doi:10.1002/jia2.70211