People living with HIV have approximately double the risk of cardiovascular diseases than the general population. To address this pressing issue and ensure healthier, longer lives for HIV-positive individuals, a groundbreaking clinical trial, the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), was conducted by investigators from Massachusetts General Hospital (MGH).

The trial’s findings, published in the New England Journal of Medicine, revealed that daily statin medication reduced the risk of major adverse cardiovascular events (MACE) by more than a third among participants living with HIV. Statins are widely used around the world as effective cholesterol-lowering drugs.

Addressing the Burden of Heart Disease in HIV

Although advances in research and treatment have extended the life expectancy of people living with HIV, heart disease and other chronic conditions have emerged as leading causes of illness and mortality among this population. Increased inflammation and immune system activation in HIV-positive individuals contribute to premature heart disease, emphasising the need for effective prevention strategies tailored to this at-risk group.

REPRIEVE Trial: Unveiling the Impact of Statins

The REPRIEVE trial, launched in 2015, enrolled 7,769 HIV-positive participants from 12 countries, representing the global diversity of the HIV population. The primary entry criteria included HIV-positive adults between 40 to 75 years of age, on antiretroviral therapy, without known cardiovascular disease, and at low to moderate risk for cardiovascular disease. These individuals were randomly assigned to receive either a daily oral 4 mg dose of pitavastatin calcium (a statin known for its safety in combination with antiretroviral therapy) or a placebo.

Promising Outcomes: Statins as a Cardiovascular Preventive Strategy

Within five years of the trial, participants taking the daily statin experienced a remarkable 35% reduction in major adverse cardiovascular events. Additionally, the statin group showed a 21% reduction in cardiovascular events or premature death. The benefits of statin therapy were consistent across various global regions and among both male and female participants.

Implications and Future Directions

The findings of the REPRIEVE trial have far-reaching implications for HIV-positive individuals worldwide. It sheds light on the potential benefits of daily statin use in reducing cardiovascular risk, beyond merely lowering cholesterol levels. Statins appear to have positive effects on inflammatory and immune pathways that may be activated in HIV, providing an additional layer of protection against heart disease.

While the results of REPRIEVE offer hope for improving the health of HIV-positive individuals, especially those within the 40 to 75 age group, researchers emphasise the importance of further studies.

As more data and research emerge, HIV treatment guidelines may expand to incorporate statins as a cardiovascular preventive strategy tailored to the unique needs of the HIV population, enhancing the overall well-being and longevity of those living with the virus.

Please note that while EMH provides ARV treatment, we do not offer or prescribe statins as part of our services. If this is something you are considering, please consult a GP, who will assess whether this is a viable addition to your treatment plan.