Background: Statin persistence and adherence are low among US adults. Most individuals with HIV in the US have high adherence to antiretroviral therapy (ART), but less is known about their statin persistence and adherence. Objectives: We analyzed persistence and adherence to statin therapy among adults with and without HIV. Methods: We analyzed claims data from adults in the MarketScan database who initiated statin therapy between 2007 and 2016. People with HIV (n = 5619) were frequency matched 1-to-4 to those without HIV (n = 22,476) based on age, sex, and calendar year of statin initiation. Statin persistence was defined by having dispensed statin medication during the last 90 days of the 365 days following initiation. High statin adherence was defined as a proportion of days covered (PDC) ≥0.80 during the 365 days following initiation. Among people with HIV, the PDC for each ART was calculated. Results: The mean age of the study population was 51 years and 85.8% were men. Statin persistence was higher among adults with versus without HIV (72.8% versus 65.2%, multivariable-adjusted prevalence ratio 1.13, 95%CI 1.11–1.15). Among those who were persistent, a higher proportion of people with versus without HIV had high statin adherence (69.6% versus 59.9%, multivariable-adjusted prevalence ratio 1.16, 95%CI 1.13–1.19). Among people with HIV and high ART adherence (minimum PDC ≥0.90), 34.6% had a PDC for statin therapy <0.80. Conclusion: Adults with HIV were more persistent and adherent to statin medications versus those without HIV. However, a high proportion of adults with HIV had low statin adherence.