HIV in adults

Guidelines recommend statins for people living with HIV to prevent cardiovascular events

People living with HIV are at greater risk of atherosclerotic cardiovascular disease (ASCVD). In order to prevent major cardiovascular events such as stroke and heart attacks, guidelines now recommend statin therapy for primary prophylaxis in people over 40 years of age who are living with HIV.

The new recommendations were informed by findings from the National Institutes of Health (NIH)-supported REPRIEVE (Randomised Trial to Prevent Vascular Events in HIV) trial, a large randomised controlled trial undertaken in people living with HIV. The trial found that pitavastatin (a moderate-intensity statin) may offset the high risk of cardiovascular disease in people living with HIV by 35%, compared to placebo, after a median follow-up of 5 years.[125]Grinspoon SK, Fitch KV, Zanni MV, et al. Pitavastatin to prevent cardiovascular disease in HIV infection. N Engl J Med. 2023 Aug 24;389(8):687-99. https://pmc.ncbi.nlm.nih.gov/articles/PMC10564556 http://www.ncbi.nlm.nih.gov/pubmed/37486775?tool=bestpractice.com  

As a consequence of this trial, the US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents with HIV now recommends at least moderate-intensity statin therapy for primary prophylaxis in people 40-75 years of age with HIV who have low to intermediate (<20%) 10-year ASCVD risk estimates. People with HIV who are less than 40 years of age or have a 10-year ASCVD risk estimate ≥20% should be treated as per the general population, based on evidence-based guidelines.[78]US Department of Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Sep 2024 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-arv/whats-new-guidelines  

The British HIV Association (BHIVA) also recommends offering statin therapy to people living with HIV over the age of 40 years, regardless of their estimated ASCVD risk or lipid profile. Patients with an estimated 10-year ASCVD risk ≥5% should be prioritised for primary prophylaxis.[126]British HIV Association. ​BHIVA rapid guidance on the use of statins for primary prevention of cardiovascular disease in people living with HIV. Mar 2024 [internet publication]. https://bhiva.org/rapid-guidance/bhiva-rapid-guidance-on-the-use-of-statins-for-primary-prevention-of-cardiovascular-disease ​[NEW REF: https://www.bhiva.org/BHIVA-rapid-guidance-on-the-use-of-statins-for-primary-prevention-of-cardiovascular-disease]

People living with HIV are twice as likely to develop cardiovascular disease, which may be related to the disease itself and/or the use of antiretroviral therapy (ART). The global burden has tripled over the past two decades and is responsible for 2.6 million disability-adjusted life years.

See Management: approach

Original source of update