Panel recommends statins for adults with HIV at risk for cardiovascular disease

In February 2024, the U.S. Department of Health and Human Services Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV (ARV Guidelines Panel), in collaboration with the American College of Cardiology (ACC), the American Heart Association (AHA), and the HIV Medicine Association (HIVMA), developed statin therapy recommendations for people with HIV (PWH).

These recommendations were informed by the results of the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) study. A summary of the recommendations relevant to physicians is published in Annals of Internal Medicine.

PWH are more at risk for many aging-related diseases, including atherosclerotic cardiovascular disease (ASCVD). The REPRIEVE study was a Phase III, global, randomized controlled trial of oral pitavastatin versus placebo for the prevention of ASCVD in PWH aged 40 to 75 years at low to intermediate risk based on 10-year risk estimates.

Compared with placebo, pitavastatin was associated with a 36% reduction in MACE. These findings informed the ARV panel to recommend moderate-intensity statin therapy as the primary prevention among PWH aged 40 to 75 years with low to intermediate 10-year ASCVD risk.

The panel also strongly recommends initiating statin therapy among people with a 10-year ASCVD risk score of 5% or higher.

For PWH with a 10-year ASCVD risk score below 5%, the panel favored statin therapy but also recommended that patient–clinician risk discussions consider HIV-related factors than can increase ASCVD risk.

Among PWH younger than 40 years, decisions to initiate statin therapy should be individualized and based on risk factors and familial health history. The panel recommends the use of at least moderate-intensity statins, including pitavastatin, 4 mg daily; atorvastatin, 20 mg daily; or rosuvastatin, 10 mg daily.

The authors note that future research is needed to better understand the absolute risk for ASCVD and other nonischemic CVD manifestations in people with HIV.