Do Statins “REPRIEVE” People Living with HIV from CV Events?

Authors:
Laura Lerner, PharmD
Joseph Nardolillo, PharmD, BCACP

Reviewers:
Julie Darnell, PharmD, BCACP, AAHIVP
Kevin Astle, PharmD, BCPS, BCACP, AAHIVP, CDCES

Citation:
Grinspoon SK, Fitch KV, Zanni MV, et al. Pitavastatin to Prevent Cardiovascular Disease in HIV Infection. N Engl J Med. 2023;389(8):687-699.

The Problem

Should statin therapy be a standard of care for people living with human immunodeficiency virus (HIV) (PLWH) at risk of atherosclerotic cardiovascular disease (ASCVD)? The elevated risk of ASCVD in PLWH is likely due to several factors, including systemic inflammation, comorbid risk factors (smoking!), and adverse lipoprotein effects of certain antiretroviral therapies (ART).¹ Advanced HIV is also associated with greater risk. For example, individuals with a viral load exceeding 1000 copies/mL have a 1.5-fold greater risk of dyslipidemia, and those with CD4 count < 100 cells/µL were more than twice as likely to have a myocardial infarction (MI).^2,3 Current guidelines and risk calculators provide suboptimal recommendations for the primary prevention of ASCVD in PLWH, particularly those who are considered “low to moderate” risk.⁴ The REPRIEVE trial investigated the benefits of statin therapy in PLWH who are at low to moderate ASCVD risk.