Risk-Guided Statin Initiation in People Living with HIV: Clinical Utility of a Cardiovascular Risk Prediction Model in a Malaysian Cohort.

Authors

Wen Yea Hwong, Hoon Shien Teh, Kim Heng Tay

Published in

Journal of the International Association of Providers of AIDS Care. Volume 25. Pages 23259582261492596. Epub Oct 09, 2026.

Abstract

BackgroundOptimal statin initiation strategies for people living with HIV (PLHIV) remain uncertain. We evaluated whether the D:A:D reduced (D:A:Dr) model improves primary prevention statin initiation decisions among Malaysian PLHIV compared with non-risk-based strategies.MethodsThis retrospective cohort study followed statin-naïve PLHIV adults from an infectious diseases centre over five years for incident cardiovascular events. Decision curve analysis compared the net benefit of a D:A:Dr-guided strategy against four alternatives: LDL-cholesterol ≥3.0 mmol/L, age ≥40 years, treat-all, and treat-none.ResultsAmong 5,741 PLHIV, 48.9% were moderate-to high-risk. The 5-year event rate was 2.0%, ranging from 0.5% (low-risk) to 8-9% (high-risk). D:A:Dr-guided strategy yielded superior net benefit at >2% - 10% threshold probabilities. Age ≥40 years lost benefits as thresholds increased whereas LDL-cholesterol-based strategy offered minimal utility.ConclusionD:A:Dr risk-based statin initiation offers superior clinical utility at >2% to 10% threshold probabilities, enabling targeted, resource-efficient prescribing in resource-constrained settings.

PMID:
42853968
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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