IAS 2023: Study shows statin lowers risks of cardiovascular events in people with HIV

A daily statin reduces the risk of major adverse cardiovascular events by 35% in people with HIV, researchers reported this week at the 12th International AIDS Society Conference on HIV Science. The NIH-funded Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) study is the first clinical study testing a cardiovascular prevention strategy in people with HIV, who are twice as likely to experience cardiovascular disease as people without HIV.

The REPRIEVE study enrolled 7,769 volunteers in 12 countries who were between 40 and 75 years of age. Participants had to be on antiretroviral therapy with a CD4 count above 100, with low to moderate risk of cardiovascular disease, and would not typically be considered for statin treatment. Those enrolled in the intervention arm received daily pitavastatin calcium at a dose of 4 mg while those in the control arm received a placebo.

In the pitavastatin group, the incidence of major cardiovascular events was 4.81 per 1,000 person-years while it was 7.32 per 1,000-person-years in the placebo group over a median follow-up of 5.1 years. Researchers noted there was a 30% reduction in LDL cholesterol in the statin arm, while there was no change in LDL levels in the placebo arm. The study’s principal investigator, Steven Grinspoon, MD, of Harvard Medical School and Massachusetts General Hospital, noted there was little interaction between pitavastatin and antiretroviral therapies, making statins safe for people on HIV treatment.

The findings, which were also published simultaneously in the New England Journal of Medicine, were met with excitement among conference attendees, including HIV care providers and people with HIV alike, as previously it was unknown if statin therapy would reduce cardiovascular risk in people with HIV. As HIV treatment continues to be scaled up and people with HIV live longer, chronic heart conditions and other noncommunicable diseases have emerged as leading causes of mortality for people with HIV, contributing to disparities in life expectancy between people with HIV and the general population, researchers noted.

“This study, supported by thousands of participants and researchers, represented a global recognition that as HIV management has grown more successful, we also need to address the comorbidities such as cardiovascular diseases that afflict people with HIV,” said acting NIAID Director Hugh Auchincloss, MD, in a news release issued by NIH.

Low- and middle-incomes countries experience higher mortality rates from cardiovascular disease, especially in Asia and Sub-Saharan Africa — several of these countries also have high or rising HIV burdens, Gerald Bloomfield, MD, MPH, of Duke University noted.

Results from the REPRIEVE study should be incorporated into HIV treatment and care guidelines, Dr. Grinspoon noted, ideally as part of primary packages of care for people with HIV.

“Low- and middle-income countries need better access to affordable statins,” he said, noting that the patent for pitavastatin expires in November 2023, which will pave the way for generic manufacturing of the drug and allow for greater access in places with high HIV burden.