Although new guidelines recommend statin use in more HIV-infected patients, most of those with evidence of coronary plaque are still not flagged as needing therapy.
A total of 108 patients without known CVD underwent coronary computed-tomography angiography (CCTA). The median age was 46 years, 50% were current smokers, and 20% were receiving antihypertensive medications. Despite the relatively low overall 10-year atherosclerotic CVD risk score (3.3%), 36% of participants had high-risk–morphology plaque detected on angiography. When the new and old guidelines were applied, several striking findings emerged:
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In the overall study population, statins would be recommended for 21% by the 2013 guidelines versus 8% by the 2004 guidelines.
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Among patients with high-risk–morphology coronary plaque, statins would be recommended for 26% by the 2013 guidelines and 10% by the 2004 guidelines.
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Among patients without coronary plaque, statins would be recommended for 15% by the 2013 guidelines versus 5% by the 2004 guidelines.
– See more at: http://www.jwatch.org/na35651/2014/09/09/cholesterol-guidelines-may-underestimate-cardiovascular#sthash.fanWUptz.dpuf
ARYAN'S BLOG 
COMMENT
The main limitation of this study is that detection of high-risk–morphology plaque on CCTA is not yet known to be predictive of CVD risk — or statin benefit — in HIV-infected patients. Nevertheless, the finding that 74% of HIV-infected patients with high-risk–morphology plaque would not qualify for statins even by the more-encompassing 2013 guidelines is alarming. Would HIV-infected patients who do not meet current guidelines benefit from statin use? A randomized clinical trial to address this question is in the offing.