If

If <5% (low) ASCVD risk:<br>
• Initiate at least moderate-intensity (30%-49% LDL-C–lowering) statin tx [CI]:<br>
&nbsp;&nbsp;◦ <a href=https://online.epocrates.com/e/deeplink/drugs/10a5744/pitavastatin><u>pitavastatin</u></a> 4 mg qd [AI]<br>
&nbsp;&nbsp;◦ <a href=https://online.epocrates.com/e/deeplink/drugs/10a879/atorvastatin><u>atorvastatin</u></a> 20 mg qd [AII]<br>
&nbsp;&nbsp;◦ <a href=https://online.epocrates.com/e/deeplink/drugs/10a3476/rosuvastatin><u>rosuvastatin</u></a> 10 mg qd [AII]<br>
• Absolute benefit is modest, so decision to initiate statin should account for presence or absence of HIV-related factors that can &uarr; ASCVD risk. Such factors include:<br>
&nbsp;&nbsp;◦ prolonged HIV infection duration<br>
&nbsp;&nbsp;◦ delayed ART initiation<br>
&nbsp;&nbsp;◦ long periods of HIV viremia or tx nonadherence<br>
&nbsp;&nbsp;◦ low current or nadir CD4 lymphocyte cell count (e.g., <350 cells/mm³)<br>
&nbsp;&nbsp;◦ exposure to older ART drugs assoc w/ cardiometabolic toxicity<br>
&nbsp;&nbsp;◦ hep C coinfection<br>
• Atorvastatin and rosuvastatin interact w/ ritonavir- and cobicistat-boosted ARVs.<br>
• If pregnant: Defer statin tx initiation until after pregnancy in pts at low to intermediate ASCVD risk. If on statin tx, discontinue. Breastfeeding is <i>not</i> recommended while on statin tx.