A New Win for Reducing CV Disease In HIV

HIV infection was once a death sentence, as patients would invariably develop AIDS and die prematurely from either infection or malignancy. Thanks to contemporary antiviral therapies, HIV is now a chronic disease that can be managed over decades of life, like hypertension and diabetes. Unfortunately, like hypertension and diabetes, HIV infection has been established as a risk factor for atherosclerotic cardiovascular disease. 

Indeed, the risk of clinical ASCVD is nearly twice as high among persons with HIV. The mechanism for this increased risk is believed to be a combination of traditional risk factors like hypertension and hypercholesterolemia, as well as immune activation and vascular inflammation resulting from the chronic viral infection. 

Few studies have evaluated the role of statins in broadly reducing rates of clinical ASCVD for primary prevention in an HIV patient population. In this week’s issue of Talking Therapeutics, we explore the findings of a new study that attempts to address this key knowledge gap. 

Score a Point for Pitavastatin

This new trial randomized nearly 8000 patients with HIV infection and low-to-moderate risk of ASCVD to either pitavastatin or placebo. Patients were followed for a median of 5.1 years, and all were well-controlled on antiviral therapy. Clinical ASCVD was a key exclusion criterion. 

The median LDL in this cohort was 108 mg/dL, and 67% had baseline LDL values between 70-130 mg/dL. Despite this relative absence of hyperlipidemia, the incidence of a major adverse cardiovascular event was 4.81 per 1000 person-years in the pitavastatin group and 7.32 per 1000 person-years in the placebo group (hazard ratio, 0.65; 95% confidence interval [CI], 0.48 to 0.90; P=0.002). These impressive results were achieved with an excellent safety profile. 

Potential Shift in HIV Primary Care

These impressive findings suggest that statins might be considered as the standard of care for patients with HIV and low-to-moderate risk factors for ASCVD regardless of serum LDL values. Clinicians should be mindful that while pitavastatin was used in this trial, this drug is currently branded in the US, and therefore a non-branded statin alternative should be used. Given the risk of drug interaction with antiviral medications, the statin selection should only be made after a careful and comprehensive review of the patient’s entire drug therapy profile.