Article Impact Level: HIGH Data Quality: STRONG Summary of Annals of Internal Medicine, ANNALS-24-03564. https://doi.org/10.7326/ANNALS-24-03564 Dr. Craig Beavers et al.
Points
- New HIV treatment guidelines now recommend statin therapy for people with HIV aged 40 to 75 years who have a 10-year cardiovascular risk of 5 percent or higher.
- These recommendations are based on the REPRIEVE study, which found that pitavastatin reduced major cardiovascular events by 36 percent in people with HIV.
- For individuals with lower cardiovascular risk or under age 40, treatment decisions should be personalized based on other risk factors and shared decision-making.
- Recommended statins include moderate-intensity options like pitavastatin, atorvastatin, or rosuvastatin, with suggested daily doses specified by the panel.
- Although these guidelines support statin use in people with HIV, more research is needed to refine cardiovascular risk assessments and understand non-ischemic disease manifestations in this population.
Summary
In February 2024, the U.S. Department of Health and Human Services (HHS) Panel for the Use of Antiretroviral Agents in Adults and Adolescents with HIV (ARV Guidelines Panel) issued statin therapy recommendations for people with HIV (PWH), in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the HIV Medicine Association (HIVMA). These guidelines were informed by the REPRIEVE study, a Phase III randomized trial that demonstrated the effectiveness of pitavastatin in preventing atherosclerotic cardiovascular disease (ASCVD) in PWH. The study showed that pitavastatin reduced major adverse cardiovascular events (MACE) by 36%, highlighting the potential benefit of statin therapy in this population.
The ARV Guidelines Panel strongly recommends initiating statin therapy in PWH aged 40 to 75 years with a 10-year ASCVD risk score of 5% or higher. For patients with a 10-year ASCVD risk below 5%, the panel supports statin use. Still, it suggests that treatment decisions should involve patient-clinician discussions, taking into account HIV-related factors that can elevate ASCVD risk. Statin therapy should consist of moderate-intensity drugs, such as 4 mg of pitavastatin, 20 mg of atorvastatin, or 10 mg of rosuvastatin daily. The panel also emphasized the importance of individualizing treatment for PWH younger than 40 years based on additional risk factors and family history.
While the guidelines suggest statin therapy for the primary prevention of ASCVD in PWH, the authors note that further research is needed to better understand the absolute risk of ASCVD in this group, especially concerning non-ischemic cardiovascular disease manifestations. The recommendations are expected to guide clinical decision-making and enhance the prevention of cardiovascular disease in PWH, aligning with broader efforts to address aging-related health risks in this population.
Link to the article: https://www.acpjournals.org/doi/10.7326/ANNALS-24-03564
References Beavers, C., Pau, A. K., Glidden, D., Hyle, E., Kuriakose, S., Martin, S. S., McComsey, G., Thompson, M., Virani, S., & Baker, J. V. (2025). Statin therapy as primary prevention for persons with hiv: A synopsis of recommendations from the u. S. Department of health and human services antiretroviral treatment guidelines panel. Annals of Internal Medicine, ANNALS-24-03564. https://doi.org/10.7326/ANNALS-24-03564
